Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty

Cohen-Rosenblum, Anna; Crutcher, Madison; Gui, Jane L; Novicoff, Wendy M.; Nelson, Stephen; Browne, James A.

doi:10.15438/rr.8.2.212

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…An electronic literature search using the PubMed, Scopus, and Google Scholar databases yielded 2419 articles. After checking for duplication and reviewing the contents of the articles, 39 articles were obtained for further analysis 6,9–46 (list of selected articles can be found in supplementary). Figure 1s…”

Section: Resultsmentioning

confidence: 99%

Use of prophylactic antibiotics on surgical site infections in arthroplasty patients (Scoping Review)

Almuhtarihan

Suharjono

Airlangga³

et al. 2022

Journal of Orthopaedics, Trauma and Rehabilitation

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Background Increased demand for arthroplasty also increases the number of complications of arthroplasty, especially surgical site infection (SSI). One of the effective strategies in preventing surgical site infection is the use of appropriate prophylactic antibiotics. Objective To identify and analyse information from clinical studies regarding factors affecting the effectiveness of prophylactic antibiotics in arthroplasty patients. Methods A scoping review was conducted through the PubMed, Scopus, and Google Scholar databases within a publication range from January 2004 to August 2020. Study data are extracted and analysed by a minimum of two reviewers. Results The search results found 2.419 articles, with 39 articles were included for further analysis. Cefazolin monotherapy was the most frequently studied antibiotic (15 articles) followed by vancomycin monotherapy (8 articles). Most widely used antibiotics in arthroplasty were cefazolin mono-therapy (997.599 procedures with SSI incidence range: 0,20–16,05%) followed by vancomycin mono-therapy (125.170 procedures with SSI incidence range: 0.27–3,88%) The correct antibiotic dose has a lower percentage of the SSI than the wrong antibiotic dose. Meanwhile, administration of antibiotics within single dose or <24 h had a lower SSI percentage than administration of antibiotics >24 h. Administration antibiotics before incision also have a lower SSI percentage than after incision. There were no studies that discussed re-dosing of antibiotics in this scoping review. Conclusions There is still a need for further research related to the duration and specific timing of first dose of prophylactic antibiotics, especially regarding single dose or multiple dose antibiotics to obtain maximum effectiveness of antibiotic prophylaxis

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Section: Resultsmentioning

confidence: 99%

Use of prophylactic antibiotics on surgical site infections in arthroplasty patients (Scoping Review)

Almuhtarihan

Suharjono

Airlangga³

et al. 2022

Journal of Orthopaedics, Trauma and Rehabilitation

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“…In an attempt to further curtail the rates of SSI in knees, various studies have compared the effectiveness of single versus dual antibiotic (i.e., cefazolin and vancomycin) prophylaxis. 5,6,[9][10][11] So far, all studies on this subject have been retrospective and the results remain inconclusive with no definitive consensus on the superiority of dual over single antibiotic prophylaxis. In general, the studies performed on this topic have defined joint infection in knees according to the Centers of Disease Control and Prevention (CDC), 31 World Health Organization (WHO) definition, 32 or the widely accepted Musculoskeletal Infection Society criteria.…”

Section: Dual Versus Single-antibiotic Prophylaxismentioning

confidence: 99%

“…8 However, recent scientific evidence has emerged both in favor of, and against the combined use of cefazolin and vancomycin (CV). 5,6,[9][10][11] The value of dual antibiotic prophylaxis in the prevention of SSI remains unclear. Particularly, the literature is inconclusive on the use of standalone cefazolin, vancomycin, or their combination.…”

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confidence: 99%

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

et al. 2019

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The risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

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Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

Gao,

Shu,

Jiang

et al. 2024

BMC Musculoskelet Disord

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Objective By reviewing the literature analyzing vancomycin powder for preventive surgery, the effect of this method on reducing the infection rate after TJA was systematically evaluated to provide a basis for future clinical work. Methods Using PubMed, Medline, Elsevier, and CNKI, with the following mesh words: “vancomycin”, “local / intraoperative / topical / intrawound”, “TJA”, “TKA”, “THA”, “total joint arthroplasty”, “total knee arthroplasty”, “total hip arthroplasty”, “infection”, and “SSI”, to search for case-control research papers on the impact of prophylactic application of vancomycin powder on the incidence of postoperative infection, we compared the overall infection rate in the literature by using RevMan 5.3 meta-analysis software and analyzed the impact of vancomycin on the infection rate of different parts and types of TJA according to different subgroups. Results A total of 22 qualified studies were selected; twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after TJA. There were 23,363 cases in total, including 9545 cases in the vancomycin group and 13,818 cases in the control group. The results of the meta-analysis showed that the possibility of postoperative infection after prophylactic use of vancomycin powder was significantly lower than that without vancomycin risk ratio: 0.38 [0.23,0.59], P < 0.01). However, a meta-analysis of randomized controlled trials (RCTs) showed no significant effect of vancomycin on postoperative infection (P = 0.52). Conclusion Based on the retrospective studies, local prophylactic use of vancomycin powder in TJA can significantly reduce the incidence of postoperative infection. High-quality RCTs should be carried out to further evaluate these results.

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Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty

Cited by 4 publications

References 22 publications

Use of prophylactic antibiotics on surgical site infections in arthroplasty patients (Scoping Review)

Use of prophylactic antibiotics on surgical site infections in arthroplasty patients (Scoping Review)

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty

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