A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

Cranny, Gillian; Elliott, Rachel A.; Weatherly, Helen; Chambers, Duncan; Hawkins, Neil; Myers, Lindsey; Sculpher, Mark; Eastwood, Alison

doi:10.3310/hta12010

Cited by 40 publications

(36 citation statements)

References 49 publications

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“…Whether the administration of combined vancomycin and cefazolin would be beneficial has not been established. Economic modeling of patients undergoing hip arthroplasty suggests that combination prophylaxis with vancomycin and cefazolin would be cost-effective where the MRSA infection rate is Ն0.25% and the rate of other infections treated with cefazolin prophylaxis is Ն0.2% (7,8). Therefore, given the rate of MRSA infection in this current study, combination prophylaxis with vancomycin and cefazolin may be cost-effective.…”

Section: Discussionmentioning

confidence: 97%

Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

Peel

Cheng

Buising

et al. 2012

Antimicrob Agents Chemother

225

140

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ABSTRACTProsthetic joint infections remain a major complication of arthroplasty. At present, local and international guidelines recommend cefazolin as a surgical antibiotic prophylaxis at the time of arthroplasty. This retrospective cohort study conducted across 10 hospitals over a 3-year period (January 2006 to December 2008) investigated the epidemiology and microbiological etiology of prosthetic joint infections. There were 163 cases of prosthetic joint infection identified. From a review of the microbiological culture results, methicillin-resistantStaphylococcus aureus(MRSA) and coagulase-negative staphylococci were isolated in 45% of infections. In addition, polymicrobial infections, particularly those involving Gram-negative bacilli and enterococcal species, were common (36%). The majority (88%) of patients received cefazolin as an antibiotic prophylaxis at the time of arthroplasty. In 63% of patients in this cohort, the microorganisms subsequently obtained were not susceptible to the antibiotic prophylaxis administered. The results of this study highlight the importance of ongoing reviews of the local ecology of prosthetic joint infection, demonstrating that the spectrum of pathogens involved is broad. The results should inform empirical antibiotic therapy. This report also provokes discussion about infection control strategies, including changing surgical antibiotic prophylaxis to a combination of glycopeptide and cefazolin, to reduce the incidence of infections due to methicillin-resistant staphylococci.

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Section: Discussionmentioning

confidence: 97%

Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

Peel

Cheng

Buising

et al. 2012

Antimicrob Agents Chemother

225

140

View full text Add to dashboard Cite

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“…The most frequent agent used was vancomycin (n=147), solely (89) or in combination. Other empirical antibiotics were co-amoxiclav (44 episodes), quinolones (23), flucloxacillin (21), aminoglycosides (18), carbapenems (15), cefepime (15), ceftriaxone (10), clindamycin (13) and piperacillin/tazobactam (2). Co-trimoxazole, daptomycin, fusidic acid, metronidazole, teicoplanin and ceftazidime were mostly co-administered with other antimicrobials in less than three cases each.…”

Section: Antibiotic Treatmentmentioning

confidence: 99%

No need for broad-spectrum empirical antibiotic coverage after surgical drainage of orthopaedic implant infections

Schindler

Gamulin

Belaieff

et al. 2013

International Orthopaedics (SICOT)

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Purpose Empirical broad-spectrum antibiotic treatment for orthopaedic implant infections after surgical lavage is common practice while awaiting microbiological results, but lacks evidence. Methods This was a single-centre cohort study from 1996 to 2010 with a follow-up of two years. Results We retrieved 342 implant infections and followed them up for a median of 3.5 years (61 recurred, 18 %). Infected implants were arthroplasties (n=186), different plates, nails or other osteosyntheses. The main pathogens were S. aureus (163, 49 methicillin-resistant) and coagulasenegative staphylococci (60, 45 methicillin-resistant). Median duration of empirical antibiotic coverage after surgical drainage was three days before switching to targeted therapy. Vancomycin was the most frequent initial empirical agent (147), followed by intravenous co-amoxiclav (44). Most empirical antibiotic regimens (269, 79 %) proved sensitive to the causative pathogen, but were too broad in 111 episodes (32 %). Cephalosporins and penicillins were used only in 44 and ten cases, respectively, although they would have covered 59 % of causative pathogens identified later. Multivariate Cox regression analysis showed that neither susceptible antibiotic coverage (compared to non-susceptible; hazard ratio 0.7, 95 % confidence interval 0.4-1.2) nor broad-spectrum use (hazard ratio 1.1, 0.8-1.5) changed remission rates. Conclusions Provided that surgical drainage is performed, broad-spectrum antibiotic coverage does not enhance remission of orthopaedic implant infections during the first three days. If empirical agents are prescribed from the first day of infection, narrow-spectrum penicillins or cephalosporins can be considered to avoid unnecessary broad-spectrum antibiotic use.

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“…[53][54][55][56][57] However, two studies were conducted by the same author group: one was a cost-effectiveness evaluation and the second was a systematic review with a cost-effectiveness evaluation. 53 As the same decision problem and decision model were used in both these publications, only the more recent and updated article was included. 55 The characteristics of the remaining four studies are summarised in Table 4.…”

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

Cited by 40 publications

References 49 publications

Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

No need for broad-spectrum empirical antibiotic coverage after surgical drainage of orthopaedic implant infections

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

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