Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 227–231 | Cite as

Targeted Use of Vancomycin as Perioperative Prophylaxis Reduces Periprosthetic Joint Infection in Revision TKA

  • Catherine Liu
  • Anthony Kakis
  • Amy Nichols
  • Michael D. Ries
  • Thomas P. Vail
  • Kevin J. BozicEmail author
Symposium: 2013 Knee Society Proceedings



The role of vancomycin in surgical antimicrobial prophylaxis and high-risk patients who are most likely to benefit remains unclear.


We determined the impact of targeted use of vancomycin on (1) the incidence of periprosthetic joint infection (PJI); and (2) the incidence of PJI from methicillin-resistant organisms in patients undergoing revision total knee arthroplasty (TKA) at our institution.


In an effort to reduce PJI rates, we added vancomycin to cefazolin as surgical antimicrobial prophylaxis for patients undergoing revision TKA in October 2010. Internal data indicated a high rate of PJI in revision TKA and in particular PJI resulting from methicillin-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). We retrospectively reviewed infection control surveillance data on 414 revision TKAs performed between July 2008 and June 2012 (fiscal years 2009–2012).


The overall rate of PJI in fiscal years 2009–2010 among 190 patients undergoing revision TKA was 7.89%. After the change in surgical antimicrobial prophylaxis, there was a significant reduction in PJI among patients undergoing revision TKA in fiscal years 2011–2012 to 3.13% (p = 0.046). In particular, we observed a reduction in PJI resulting from methicillin-resistant organisms over this same time period, from 4.21% to 0.89% (p = 0.049).


Targeted use of vancomycin in patients undergoing revision TKA was effective in reducing the rate of PJI and PJI resulting from methicillin-resistant organisms in an institution with a high baseline rate of PJI due to MRSA and MRSE. Identification of high-risk subgroups of patients within a surgical population can help target infection prevention strategies to those who are most likely to benefit and thus minimize potential risks (eg, selection of resistant organisms, adverse drug events) associated with broader application of such an intervention.

Level of Evidence

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


Vancomycin Total Knee Arthroplasty Cefazolin Periprosthetic Joint Infection Primary Total Knee Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Laurel Gibbs MT, CIC, for her assistance with data collection and validation, Steven Takemoto PhD, for providing assistance with data analysis, and Vanessa Chan MPH, for her help in preparing the manuscript.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Catherine Liu
    • 1
  • Anthony Kakis
    • 2
  • Amy Nichols
    • 2
  • Michael D. Ries
    • 3
  • Thomas P. Vail
    • 3
  • Kevin J. Bozic
    • 3
    • 4
    Email author
  1. 1.Division of Infectious Diseases, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Hospital Epidemiology and Infection ControlUniversity of California, San Francisco Medical CenterSan FranciscoUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of California, San Francisco Medical CenterSan FranciscoUSA
  4. 4.Philip R. Lee Institute for Health Policy StudiesUniversity of California, San Francisco Medical CenterSan FranciscoUSA

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