Articles | Volume 10, issue 6
https://doi.org/10.5194/jbji-10-609-2025
https://doi.org/10.5194/jbji-10-609-2025
Original full-length article
 | 
19 Dec 2025
Original full-length article |  | 19 Dec 2025

Renal safety of intraoperative local vancomycin powder application in orthopedic surgery: a retrospective analysis

Juliane Beschauner, Maria Felsberg, Alexander Zeh, Karl-Stefan Delank, Natalia Gutteck, and Felix Werneburg

Cited articles

Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., Morgan, S., Solomkin, J. S., Mazuski, J. E., Dellinger, E. P., Itani, K. M. F., Berbari, E. F., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J. A. J. W., Donlan, R., and Schecter, W. P.: Healthcare Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, JAMA Surgery, 152, 784–791, https://doi.org/10.1001/jamasurg.2017.0904, 2017. 
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., Steinberg, J. P., and Weinstein, R. A.: American Society of Health-System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, & Society for Healthcare Epidemiology of America, Clinical practice guidelines for antimicrobial prophylaxis in surgery, American journal of health-system pharmacy, AJHP, 70, 195–283, https://doi.org/10.2146/ajhp120568, 2013. 
Brothers, K. M., Parker, D. M., Taguchi, M., Ma, D., Mandell, J. B., Thurlow, L. L., Byrapogu, V. C., and Urish, K. L.: Dose optimization in surgical prophylaxis: sub-inhibitory dosing of vancomycin increases rates of biofilm formation and the rates of surgical site infection, Scientific Reports, 13, 4593, https://doi.org/10.1038/s41598-023-30951-y, 2023. 
Bunea, A., Lăptoiu, D., Târcomnicu, I., Oţelea, D., Popescu, G., and Marinescu, R.: In vivo systemic vancomycin determination from polymethyl methacrylate and morselized bone allograft used in two stage septic knee revision arthroplasty, Germs, 14, 294–300, https://doi.org/10.18683/germs.2024.1440, 2024. 
Chan, C., Lee, M. C., and Wong, J. Y.: Topical vancomycin in primary and revision total joint arthroplasty: a systematic review and meta-analysis, J. Arthroplasty, 39, 320–329, 2024. 
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Short summary
We studied whether placing vancomycin powder directly into the wound during orthopedic surgery harms the kidneys. In 50 patients, kidney function before and after surgery stayed essentially stable, even with higher doses. Our findings suggest that this local antibiotic strategy is unlikely to cause short-term kidney damage.
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