Thursday, November 27, 2014

Antibiotic prophylaxis in joint arthroplasty - is Vancomycin a worthwhile addition or not?

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

These authors performed a retrospective study of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis looking for evidence of acute kidney injury after surgery.

They found that patients receiving dual antibiotics were more likely to develop kidney injury compared with those receiving cefazolin alone (13% versus 8%, p = 0.002) and that patients receiving dual-antibiotic prophylaxis had higher rates of Grade II and III acute kidney injury.
However, there was no difference in the rate of return to baseline renal function.

Preoperative kidney disease and higher ASA classification were independent risk factors for AKI after primary total joint arthroplasty.

Comment: Because of our concern for coagulase negative staphylococcus (mecA positive) in shoulder arthroplasty, we use Vancomycin and Ceftriaxone as our routine prophylaxis for 24 h after surgery. We have not demonstrated the efficacy of this program over other forms of antibiotic prophylaxis, however. We are careful to assure adequate hydration, to adjust the dose in individuals with compromised renal function, and to administer the Vancomycin slowly to minimize the risk of renal toxicity.


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