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

  • Symposium: 2011 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Introduction

It is unclear which antibiotic regimen provides the best prophylaxis against surgical site infection (SSI) in patients undergoing hip and knee surgery.

Questions/purposes

Therefore, we determined whether dual antibiotic prophylaxis (1) reduced the rate of SSI compared to single antibiotic prophylaxis and (2) altered the microbiology of SSI.

Methods

We retrospectively reviewed 1828 primary THAs and TKAs performed between September 1, 2008 and December 31, 2010. We divided patients into two groups: (1) those who received a dual prophylactic antibiotic regimen of cefazolin and vancomycin (unless allergy), or (2) received cefazolin (unless allergy) as the sole prophylactic antibiotic. There were 701 males and 1127 females with an average age of 56 years (range, 15–97 years). We limited followup to 1 year, presuming subsequent infections were not related to the initial surgery.

Results

During this period, there were 22 SSIs (1.2%). The infection rates for dual antibiotic prophylaxis compared to a single antibiotic regimen were 1.1% and 1.4%, respectively. Of 1328 patients treated with dual antibiotic prophylaxis, only one (0.08%) SSI was culture positive for methicillin resistant Staphylococcus aureus (MRSA), while four of 500 patients (0.8%) receiving only cefazolin prophylaxis had culture positive MRSA infection at the time of reoperation.

Conclusion

The addition of vancomycin as a prophylactic antibiotic agent apparently did not reduce the rate of SSI compared to cefazolin alone. Use of vancomycin in addition to cefazolin appeared to reduce the incidence of MRSA infections; however, the number needed to treat to prevent a single MRSA infection was very high.

Level of Evidence

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

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Acknowledgments

The authors thank Jonathan P Garino MD, Charles L Nelson MD, and Craig L Israelite MD for contributing patients for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Amy Sewick MD, Amun Makani MD, Chia Wu MD, Keith D. Baldwin MD, MPH, MSPT & Gwo-Chin Lee MD

  2. Department of Infectious Disease, Presbyterian Medical Center, Philadelphia, PA, 19104, USA

    Judith O’Donnell MD

Authors
  1. Amy Sewick MD
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  2. Amun Makani MD
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  3. Chia Wu MD
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  4. Judith O’Donnell MD
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  5. Keith D. Baldwin MD, MPH, MSPT
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  6. Gwo-Chin Lee MD
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Corresponding author

Correspondence to Gwo-Chin Lee MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sewick, A., Makani, A., Wu, C. et al. Does Dual Antibiotic Prophylaxis Better Prevent Surgical Site Infections in Total Joint Arthroplasty?. Clin Orthop Relat Res 470, 2702–2707 (2012). https://doi.org/10.1007/s11999-012-2255-1

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