Does Dual Antibiotic Prophylaxis Better Prevent Surgical Site Infections in Total Joint Arthroplasty?

Abstract

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

CORR Insights®: Addition of Vancomycin to Cefazolin Prophylaxis Is Associated with Acute Kidney Injury After Primary Joint Arthroplasty

“…On the surface, this study appears to validate the concept that dual antibiotic regimen including vancomycin increases the risk of acute kidney injury. Additionally, a previous study of this series of patients has shown that the addition of vancomycin to the prophylactic antibiotic regimen did not result in less surgical site infections than cefazolin alone [6]. This was consistent with other studies [5,9].…”

“…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].…”

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

“…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.…”

“…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. Sewick et al [12] evaluated the use of dual antibiotics (vancomycin and cefazolin) with cefazolin monotherapy and found no difference in the infection rate (1.1% versus 1.4%; p = 0.64). In contrast, Ponce et al [11] revealed that vancomycin (2.3%) demonstrated an approximately two times higher rate of 30-day SSI than cefazolin (1.3%, adjusted OR 1.73) and clindamycin (1.1%).…”

“…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].…”