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

Abstract

I nfection after total joint arthroplasty (TJA) is a devastating complication that causes tremendous morbidity and accounts for a substantial proportion of orthopaedic healthcare expenditures. The treatment of periprosthetic infection also can be a source of considerable unease and confusion for arthroplasty surgeons. The proportion of patients who develop infection after TJA is low, at approximately 1% to 2% [8, 10]. Surgeons can help keep the risk of infection low by using appropriate perioperative antimicrobial prophylaxis, laminar airflow, antibiotic-impregnated cement, and decreased traffic in the operating room. Although patients, and to some degree even the healthcare system in theUnited States, seem to have an expectation that this complication should never occur, the reality is that prosthetic infection is unlikely to be eliminated in the next few years. The choice of antimicrobial regimen is currently based on the results of experimental studies and clinical experience, but we still lack randomized clinical trials (RCTs) [2–4]. It has been suggested that in some settings, particularly those in which the local antibiogram includes a high proportion of infections with methicillin-resistant Staphyloccus aureus (MRSA), vancomycin may be appropriate for prophylactic antibiotic regimens [1, 7]. However, researchers have observed complications in patients with routine administration of vancomycin including resistant bacteria, acute kidney injury, and hearing loss. 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 [5–7]. In this study, Courtney and colleagues retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty during a 2-year period. These patients received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as prophylactic perioperative antibiotics. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were This CORR Insights is a commentary on the article ‘‘Addition of Vancomycin to Cefazolin Prophylaxis Is Associated with Acute Kidney Injury After Primary Joint Arthroplasty’’ by Courtney and colleagues available at: DOI: 10.1007/s11999-0144062-3. The authors certify that they, or any members of their immediate families, have no funding or 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. 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. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999014-4062-3. H.-X. Zhu MD, X.-Z. Cai MD (&) Department of Orthopedic Surgery, Second Affiliated Hospital’s Campus in Binjiang District, School of Medicine, Zhejiang University, No. 1511 Jianghong Road, Hangzhou 310009, People’s Republic of China e-mail: emilcai@hotmail.com CORR Insights Published online: 6 January 2015 The Association of Bone and Joint Surgeons1 2015