Comparative Multicenter Trial of Teicoplanin versus Cefazolin for Antimicrobial Prophylaxis in Prosthetic Joint Implant Surgery

Abstract

A randomized multicenter study was carried out in 12 centers in Italy to compare administration of a single dose of teicoplanin (400 mg i.v. bolus at time of anesthesia) versus that of five doses of cefazolin over a 24-h period (2 g at induction of anesthesia and 1 g every 6 h postoperatively, i.v. bolus) as antimicrobial prophylaxis in patients undergoing hip or knee arthroplasty. Of 860 patients enrolled, 427 received teicoplanin and 433 cefazolin. A total of 846 patients (422 teicoplanin and 424 cefazolin) were evaluable for safety and 826 patients for efficacy. Six patients (1.5%) in the teicoplanin group and seven patients (1.7%) in the cefazolin group developed a surgical wound infection during their postoperative hospital stay: this difference was not significant. Proven or suspected infections involving other body systems occurred in 114 patients (57 in each group). Seven hundred ninety-two patients completed a 3-month evaluation and 738 patients a 12-month evaluation: the success rates in evaluable patients at these observation times were 99.2% and 99.7% for teicoplanin and 99.2% and 99.7% for cefazolin, respectively. Adverse events occurred in three (0.7%) teicoplanin patients and nine (2.1%) cefazolin patients (P = 0.083). A single preoperative dose of teicoplanin ensures adequate surgical antisepsis, with results comparable to a standard multiple-dose regimen of cefazolin.

The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip

“…In elective arthroplasty surgery, trials have compared different antibiotic regimens in primary THA and total knee arthroplasty, 38 differences between locally delivered and systemic antibiotics 39 and with high versus low viscosity cement. 40 The use of antibiotic cement for primary THA is now accepted as an effective means of prophylaxis against SSIs.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…165 The introduction of antimicrobial prophylaxis, stringent infectioncontrol protocols, and the use of ultraclean operating rooms has led to a substantial reduction in SSI rates (to ≤1%). 734,786,796,798,799 Postoperative prosthetic joint infection is an organ/ space SSI that occurs early (within 3 months postoperatively), is delayed (3-12 months postoperatively), or occurs late (>12 months after surgery). 748 These infections frequently require removal of the prosthesis, a prolonged course of antimicrobials, and one-or two-stage reimplantation of the prosthesis and may result in permanent disability.…”

PLGA and PHBV Microsphere Formulations and Solid-State Characterization: Possible Implications for Local Delivery of Fusidic Acid for the Treatment and Prevention of Orthopaedic Infections

“…But even with modern day sterilization, aseptic surgical procedures and ultra-clean operation rooms, orthopaedic surgeries can still be complicated by infections (1). Thus, the treatments (2)(3)(4)(5) and prevention (6)(7)(8)(9) of orthopaedic infections have utilized prolonged systemic antibiotic therapy. However, serious problems can arise from this approach, including a failure to produce therapeutic tissue concentrations of the antibiotics because of relatively low vascularity within necrotic bone and implant in prosthetic joint infections.…”