Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2023;11(21):2 N Engl J Med. 2023 Oct 19;389(16):1488-1498.What this means for my practice?
Adding vancomycin to cefazolin in arthroplasty patients did not significantly reduce the incidence of surgical site infection, and may even increase the risk of hypersensitivity reaction, as well as the risk of superficial surgical site infection in knee arthroplasty cases. This study was limited by the small number of revision surgery patients, who are at increased risk of staphylococcus-resistant microbe infection.
Study Summary
4,239 patients undergoing an arthroplasty surgery were randomized to received infection prophylaxis with vancomycin and cefazolin (n=2,118) or cefazolin alone (n=2,121). The primary outcome of interest was the incidence of surgical site infection at 90 days post-operation. Secondary outcomes of interest included superficial, deep, and organ-space infection; deep or organ-spaced infections between 90-180 days; surgical-site infections with methicillin-resistant staphylococcus species, and safety outcomes. The incidence of surgical-site infection not significantly different between the vancomycin-cefazolin combination group and the cefazolin group. The combination group reported significantly higher rates of hypersensitivity reaction, and a higher rate of superficial surgical-site infection in knee arthroplasty patients. No other between-group differences were observed.
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