Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty
DOI:
https://doi.org/10.15438/rr.8.2.212Keywords:
Antibiotic Prophylaxis, Primary Total Knee Arthroplasty, Infection, Renal FailureAbstract
Background: Perioperative administration of intravenous antibiotics is a routine part of total knee arthroplasty. Antibiotic selection is a matter of controversy, and the potential risks and benefits associated with each antibiotic selection need to be considered. The objective of this study is to examine the effects of routine dual antibiotic prophylaxis with both cefazolin and vancomycin on infection and renal failure after primary total knee arthroplasty (TKA) compared with cefazolin alone.
Methods: We performed a retrospective review of primary TKA patients for two years before and two years after routine dual antibiotic prophylaxis was implemented at our institution. 1502 patients were included (567 cefazolin-only and 935 dual prophylaxis).
Results: 2 patients (0.4%) in the cefazolin-only group had a deep surgical site infection, compared with 13 patients (1.4%) in the dual prophylaxis group (p=0.06). 46 patients (8.1%) in the cefazolin-only group had postoperative renal failure, compared with 36 patients (3.9%) in the dual prophylaxis group (p=0.0006).
Discussion and Conclusion: Our results did not support the routine use of vancomycin in primary total joint arthroplasty to decrease periprosthetic joint infection. However, we also did not see any clear harm due to renal failure in the routine use of dual antibiotic prophylaxis.
References
American Academy of Orthopaedic Surgeons: Information statement: Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty. AAOS information statement 1027. https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1027%20Recommendations%20for%20the%20Use%20of%20Intravenous%20Antibiotic%20Prophylaxis%20in%20Primary%20Total%20Joint%20Arthroplasy.pdf Accessed October 14, 2017.
Campbell K, Spencer S, Looze C, et al. Antibiotic stewardship in orthopaedic surgery: Principles and practice. J Am Acad Orthop Surg 2014;22:772-81.
Bosco J, Bookman J, Slover J, et al. Principles of antibiotic prophylaxis in total joint arthroplasty: Current concepts. J Am Acad Orthop Surg 2015;23:e27-35.
Albuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90(7):915-19.
Parvizi J, Gherke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013;95-B:1450-2.
Klein E, Mojica N, Jiang W, et al. Trends in methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010-2014. Clin Infect Dis 2017. doi: 10.1093/cid/cix640
Parvizi J, Pawasarat I, Azzam K, et al. Periprosthetic joint infection. J Arthroplasty 2010;25(6):103-7.
Smith E, Wynne R, Joshi A, et al. Is it time to include vancomycin for perioperative antibiotic prophylaxis in total joint arthroplasty patients? J Arthroplasty 2012;27(8):55-60.
Liu C, Kakis A, Nichols A, et al. Targeted use of vancomycin as perioperative prophylaxis reduces periprosthetic joint infection in revision TKA. Clin Orthop Relat Res 2014;472:227-31.
Crawford T, Rodvold K, Solomkin J. Vancomycin for surgical prophylaxis? Clin Infect Dis 2012;54(10):1474-9.
Vaisman A, McCready J, Hicks S, et al. Optimizing preoperative prophylaxis in patients with reported ß-lactam allergy: A novel extension of antimicrobial stewardship. J Antimicrob Chemother 2017;72:2657-2660.
Bratzler D, Dellinger P, Olsen K, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 2013;70:195-283.
Branch-Elliman W, Ripollone J, O’Brien W, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study. PLoS Med 2017;14(7):e1002340.
Vandecasteele SJ, De Vriese AS, Tacconelli E. The pharmacokinetics and pharmacodynamics of vancomycin in clinical practice: Evidence and uncertainties. J Antimicrob Chemother 2013;68:743-8.
Courtney P, Melnic C, Zimmer Z, et al. Addition of vancomycin to cefazolin prophylaxis is associated with acute kidney injury after primary joint arthroplasty. Clin Orthop Relat Res 2015;473:2197-2203.
Sewick A, Makami A, Wu C, et al. Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty? Clin Orthop Relat Res 2012;470:2702-7.
Burger J, Hansen B, Leary E, Aggarwal A, Keeney J. Dual-Agent Antibiotic Prophylaxis Using a Single Preoperative Vancomycin Dose Effectively Reduces Prosthetic Joint Infection Rates With Minimal Renal Toxicity Risk. J Arthroplasty. 33 (2018) S213-S218
WHO Surgical Site Infection Prevention Guidelines. http://www.who.int/gpsc/appendix13.pdf, accessed 2/11/18.
Parvizi J, Zmistowski B, Berbari E, et al. New definition for prosthetic join infection: From the workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2012;469:2992-4.
Classification/Staging System for Acute Kidney Injury. http://www.akinet.org/akinstudies.php, accessed 2/11/18.
Harold RE, Butler BA, Lamplot J, Luu HH, Lawton CD, Manning D. Multifaceted aseptic protocol decreases surgical site infections following hip arthroplasty. Hip Int 2017. https://doi.org/10.5301/hipint.500055.
Lamplot JD, Luther D, Mawdsley EL, Luu HH, Manning D. Modified protocol decreases surgical site infections after total knee arthroplasty. J Knee Surg 2015;28:395e403.
Ponce B, Raines BT, Reed R, et al. Surgical site infection after arthroplasty: Comparative effectiveness of prophylactic antibiotics. Do Surgical Care Improvement Project Guidelines need to be updated? J Bone Joint Surg Am 2014;96:970-7.
Tan T, Springer B, Ruder J, et al. Is vancomycin-only prophylaxis for patients with penicillin allergy associated with increased risk of infection after arthroplasty? Clin Orthop Relat Res 2016;474:1601-6.
Kheir M, Tan T, Azboy I, et al. Vancomycin prophylaxis for total joint arthroplasty: Incorrectly dosed and has a higher rate of periprosthetic infection than cefazolin. Clin Orthop Relat Res 2017;475:1767-74.
Published
How to Cite
Issue
Section
Copyright (c) 2018 Anna Rosenblum, Madison Crutcher, Jane Gui, Wendy Novicoff, Stephen Nelson, James Browne
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
