Topical Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: TOBRA
Study Details
Study Description
Brief Summary
The overall objective is to compare the effect of Vancomycin and Tobramycin powder combined (treatment) to Vancomycin powder (control) in the reduction of post-fixation infections of tibial plateau and tibial pilon fractures at high risk of infection (collectively considered the "study injuries").
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 3 |
Detailed Description
Specific Aim 1: Compare the proportion of deep surgical site infections (SSI) of the study injury within 365 days of definitive fracture fixation surgery in patients allocated to receive a combination of local Vancomycin and Tobramycin powders compared to patients allocated to local Vancomycin powder.
Sensitivity Analyses: A series of sensitivity analyses will be conducted to look at alternative measures of deep SSI under Specific Aim 1. These sensitivity analyses will consider the following alternative end points of deep SSI: infection by gram-negative bacteria, infection by gram-positive bacteria, polymicrobial pathogenic infections, culture negative infections, and cellulitis/skin infections.
Specific Aim 2: To compare the safety of treatment with a combination of local Vancomycin and Tobramycin versus Vancomycin powder alone as measured by the proportion of antibiotic resistance in each arm.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Control Standard of Care + Local Vancomycin: Participants in the control group will receive a dose of 1000mg of Vancomycin powder in their wound bed immediately before wound closure. |
Drug: Control group
Standard of Care + Local Vancomycin: Participants in the control group will receive a dose of 1000mg of Vancomycin powder in their wound bed immediately before wound closure.
Other Names:
|
| Experimental: Treatment Standard of Care + Local Vancomycin + Local Tobramycin: Participants in the treatment group will receive a dose of 1000mg of Vancomycin powder AND a dose of 1200mg of Tobramycin powder in their wound bed immediately before wound closure. |
Drug: Treatment group
Standard of Care + Local Vancomycin + Local Tobramycin: Participants in the treatment group will receive a dose of 1000mg of Vancomycin powder AND a dose of 1200mg of Tobramycin powder in their wound bed immediately before wound closure.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Deep Surgical Site Infection (SSI) [within 365 days of definitive fracture fixation surgery]
Compare the proportion of deep SSIs of the study injury within 365 days of definitive fracture fixation surgery in patients treated with local Vancomycin powder compared to those treated with a combination of local Vancomycin and Tobramycin powders. For this study a "deep SSI" is a SSI that is treated with operative debridement. In the current CDC terminology this would include all deep organ space, deep incisional, and superficial infections that are treated with surgery.
Secondary Outcome Measures
- Sensitivity analyses [within 365 days of definitive fracture fixation surgery]
These sensitivity analyses will consider the following alternative end points of deep SSI: infection by gram-negative bacteria, infection by gram-positive bacteria, polymicrobial pathogenic infections, culture negative infections, and cellulitis/skin infections.
- Antibiotic resistance [within 365 days of definitive fracture fixation surgery]
To compare the safety of treatment with a combination of local Vancomycin and Tobramycin versus Vancomycin powder alone as measured by the proportion of antibiotic resistance in each arm.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Tibial plateau or tibial pilon fractures that is treated operatively with plate and screw fixation AND at least one of the following characteristics indicative of higher risk of infection:
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Initially treated with an external fixation and treated definitively more than 3 days later after swelling has resolved.
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Any open type I, II, or IIIA fracture, regardless of timing of definitive treatment.
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Tibia fracture is associated with ipsilateral leg compartment syndrome and fasciotomy wounds.
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Patients ages 18 through 80 years.
Exclusion Criteria:
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Study injury is already infected at time of study enrollment.
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Definitive fixation of the study injury prior to enrollment in the study.
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The patient never receives study fixation.
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Massive myonecrosis from ipsilateral leg compartment syndrome.
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Currently pregnant.
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Severe problems with maintaining follow-up (e.g. patients who are homeless at the time of injury, those who are intellectually challenged without adequate family support, or are unwilling to provide phone and address contact information).
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Patients with allergies, drug administration reactions, or other sensitivities to Vancomycin (such as a history of Redman's Syndrome).
-
Patients with allergies, drug administration reactions, or other sensitivities to Tobramycin or other aminoglycosides.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Maryland Shock Trauma Center | Baltimore | Maryland | United States | 21201 |
Sponsors and Collaborators
- Major Extremity Trauma Research Consortium
Investigators
- Principal Investigator: Robert V O'Toole, MD, MS, University of Maryland, Department of Orthopaedic Trauma
- Principal Investigator: Renan C Castillo, PhD, Johns Hopkins Bloomberg School of Public Health
- Study Director: Anthony R Carlini, MS, Johns Hopkins Bloomberg School of Public Health
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- W81XWH-19-1-0848