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Vancomycin and cefazolin seen as a safe prophylactic regimen against MRSA in open fractures
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SAN ANTONIO — Researchers from the University of Colorado School of Medicine in Denver discovered higher rates of methicillin-resistant Staphylococcus aureus in patients with open fractures and that the addition of vancomycin to cefazolin is a safe prophylactic method against the organism.
“Staphylococcus aureus is the number one cause of surgical site infection,” Carla C. Saveli, MD, said in her presentation at the 2011 Annual Meeting of the Orthopaedic Trauma Association. “Therefore, it should be the main target for prophylaxis. The current standard of care for patients with open fractures is to administer a first-generation cephalosporin […] from presentation and for 24 to 48 hours after wound closure.”
“The benefits of antibiotic prophylaxis in open fractures have been clearly demonstrated in several randomized controlled trials, but the choice of antibiotic remains controversial since the current guidelines do not recommend agents with [methicillin-resistant Staphylococcus aureus] MRSA activity,” the authors wrote in their abstract.
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Image: Saveli CC |
The researchers designed a study to measure the incidence of MRSA in patients presenting to emergency departments with open fractures and to compare a cohort given standard antibiotic prophylaxis treatment to one given MRSA-targeted antibiotics. The study included 130 patients who were randomized to receive either cefazolin alone or vancomycin and cefazolin from presentation at the emergency room until 24 hours postoperatively. The team screened each patient using nasals swabs and assessed wound cultures before and after fracture debridement. Patients were also assessed for no less than 30 days and up to 24 months postoperatively.
The investigators found that 24% of the general population was colonized with S. aureus and 3% had a methicillin-resistant strain. They recorded 17 cases of surgical site infections; eight in the cefazolin group and nine in the cefazolin and vancomycin group. Of those patients, 11 went to the operating room for debridement and culture. Of these patients, 55% had S. aureus as the main culprit of their infection — 36% which were methicillin susceptible and 18% which were methicillin resistant.
“Staphylococcus aureus colonization in orthopedic trauma patients is similar to the general population, and we found a 3% rate of methicillin resistance in our study cohort,” Saveli said. “ … Preliminary findings demonstrate that the addition of vancomycin to target MRSA prophylaxis is safe. We would like to propose a multicenter study, not only looking at the safety, but also the efficacy of MRSA coverage for prophylaxis in order to prevent surgical site infection.” – by Renee Blisard
Reference:
- Saveli CC, Morgan SJ, Belknap RW, et al. The role of antibiotics in open fractures revisited: Characteristics of Staphylococcus aureus (SA) and susceptibility profile. Paper #54. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
- Carla C. Saveli, MD, can be reached at the University of Colorado, 1635 Aurora Ct., Aurora, CO 80045; 720-848-0191; email: carla.saveli@ucdenver.edu.
- Disclosure: Saveli has no relevant financial disclosures.