Adding vancomycin to surgical antimicrobial prophylaxis did not decrease SSI risk
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Key takeaways:
- The incidence of SSIs was similar between patients given vancomycin or placebo in addition to standard surgical antimicrobial prophylaxis.
- The incidence of adverse events was also similar between groups.
Adding vancomycin to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections among patients without known MRSA infection undergoing joint arthroplasty, researchers found.
“We had observed an increased number of patients undergoing arthroplasty, or joint replacement surgery, who had developed a postoperative wound infection, or surgical site infection (SSI), with a resistant bacteria,” Trisha N. Peel, MB, BS, PhD, deputy director of researcher and antimicrobial stewardship services lead at Alfred Hospital and Epworth HealthCare, told Healio.
“We wondered whether the addition of an antibiotic (vancomycin) to standard surgical antibiotic prophylaxis (with cefazolin) would help to prevent these postoperative wound infections in patients undergoing arthroplasty (who did not have MRSA),” Peel said.
To assess the efficacy of adding vancomycin to standard surgical antibiotic prophylaxis, Peel and colleagues conducted a phase 4, multicenter, double-blind, superiority, placebo-controlled trial during which they randomly assigned patients without known MRSA colonization who were undergoing arthroplasty to receive 1.5 g of vancomycin or normal saline placebo in addition to standard surgical antimicrobial prophylaxis with cefazolin. According to the study, the primary outcome was SSI within 90 days after surgery.
In total, 4,239 patients underwent randomization, and among the 4,113 patients in the modified intention-to-treat population — 2,233 of whom were undergoing knee arthroplasty, 1,850 hip arthroplasty and 30 shoulder arthroplasty — SSIs occurred in 91 of 2,044 patients (4.5%) in the vancomycin group and in 72 of 2,069 patients (3.5%) in the placebo group (RR = 1.28; 95% CI, 0.94-1.73).
When assessed by arthroplasty type, the study showed that SSIs occurred in 5.7% of patients in the vancomyin group and in 3.7% of patients in the placebo group undergoing knee arthroplasty, 3% of patients in the vancomyin group and in 3.1% of patients in the placebo group undergoing hip arthroplasty.
The study also showed that adverse events occurred in 1.7% of patients in the vancomycin group and in 1.7% of patients in the placebo group, and included hypersensitivity reactions and acute kidney injury.
“Current antibiotic prophylaxis with cefazolin is the best approach to prevent postoperative wound infections in patients undergoing arthroplasty who do not have MRSA colonization,” Peel said. “The addition of vancomycin did not offer any additional benefit in this group of patients.”
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