Background: Topical vancomycin powder is increasingly applied intraoperatively to prevent surgical site infections (SSI) in orthopedic surgery. While intravenous vancomycin carries a well-documented risk of nephrotoxicity, systematic data on the renal safety of intrawound application remain limited.

Methods: Retrospective single-centre cohort study of 50 adults undergoing orthopedic surgery (spinal, arthroplasty, septic and aseptic revision procedures) with intraoperative local vancomycin powder (January–July 2024). Serum creatinine and eGFR were assessed preoperatively and at two postoperative time points (median day 1 and day 3). Primary endpoint: acute kidney injury (AKI) per KDIGO serum creatinine criteria; prespecified subgroups: nephrotoxic co-medication, application plane (epifascial/subfascial), dose (< 1000 vs. ≥ 1000 mg), indication (aseptic/septic).

Results: Median dose was 1000 mg (range 500–4000). AKI occurred in 2/50 patients (4 %), both KDIGO stage 1, both with concomitant nephrotoxic medication; no stage 2–3 events. Serum creatinine showed no systematic postoperative increase and eGFR no central shift; AKI incidence did not differ across subgroups (all p > 0.05).

Conclusion: Intraoperative local vancomycin powder application was not associated with short-term renal impairment, supporting its renal safety as an adjunct for SSI prophylaxis. Full text (Open Access): Beschauner et al., J Bone Joint Infect 2025;10:609–615, doi.org/10.5194/jbji-10-609-2025.

Keywords: vancomycin powder, intrawound, topical antibiotics, surgical site infection, nephrotoxicity, acute kidney injury, KDIGO, renal safety, orthopedic surgery