Is it Time to Include Vancomycin for Routine Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty Patients?

Smith, Eric B.; Wynne, Rachael; Joshi, Anand; Liu, Hans; Good, Robert P.

doi:10.1016/j.arth.2012.03.040

Cited by 69 publications

(54 citation statements)

References 22 publications

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“…Many prior studies have compared vancomycin with cephalosporins and have demonstrated conflicting results [11][12][13]16]. These studies are rarely focused on the blactam-allergic population and frequently represent the outcomes of universally administering vancomycin.…”

Section: Discussionmentioning

confidence: 99%

“…These studies are rarely focused on the blactam-allergic population and frequently represent the outcomes of universally administering vancomycin. In a series of 5,036 primary TJAs, Smith et al [13] found that transitioning from cefazolin to vancomycin resulted in a significant reduction of PJI from 1% to 0.5% [13]. Tyllianakis et al [16] demonstrated no difference (six of 188 versus six of 120) in the SSI or PJI rate between those receiving cefuroxime and vancomycin in a prospective randomized trial in nonpenicillin-allergic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although many studies have compared the efficacy of vancomycin with cefazolin for preventing periprosthetic joint infection (PJI), the results have been mixed with some studies achieving excellent results with vancomycin alone [11][12][13]16], but a recent large study suggested that vancomycin monotherapy is associated with increased risk of infection compared with cefazolin [11].…”

Section: Introductionmentioning

confidence: 99%

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Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. Questions/purposes (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy?Methods We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between b-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. Results After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI,; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…It has been suggested that in some settings, particularly those in which the local antibiogram includes a high proportion of infections with methicillin-resistant Staphyloccus aureus (MRSA), vancomycin may be appropriate for prophylactic antibiotic regimens [1,7]. However, researchers have observed complications in patients with routine administration of vancomycin including resistant bacteria, acute kidney injury, and hearing loss.…”

mentioning

confidence: 99%

“…Moreover, Vancomycin needs to be combined with traditional prophylactic agents in order to provide coverage against Gram-negative bacteria. The benefits to adding vancomycin to prophylactic regimens is still hotly debated [5][6][7].…”

mentioning

confidence: 99%