Editor's Spotlight/Take 5: Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty.

Abstract

W hen the cure is difficult or dangerous, prevention becomes especially important. This is particularly relevant in the care of patients with prosthetic joint infections, where a cure might entail several operations and loss of a weight-bearing implant. When antibiotic resistant organisms are thrown into the mix, finding effective prevention measures is not that simple. From the moment we began making antibiotics, bacteria have been working on resisting them. Among the most worrisome resistant organisms we see is methicillin-resistant Staphylococcus aureus (MRSA), and the incidence of MRSA infection is increasing [2, 5, 7]. In response, some institutions began using antibiotic regimens with wider coverage and coverage specifically to address the prevalence of MRSA, in places where it is prevalent; specifically, the use of vancomycin as presurgical prophylaxis to combat MRSA has been reported, with some apparent benefits [6]. Also added to the armamentarium were decolonization protocols with varying levels of success [3, 4]. Interestingly, a recent report found that 20% of patients undergoing elective total joint arthroplasty may be colonized with MRSA despite undergoing a screening and decolonization protocol; perhaps not surprisingly in that setting, the protocol was ineffective in decreasing infection rate [1]. Because of the challenges surgeons see with respect to decolonization, and because strains of resistant Grampositive bacteria are endemic in some tertiary-care hospital settings, dualantibiotic prophylaxis—often using vancomycin in addition to a first-generation cephalosporin—sometimes is used. Dr. Gwo-Chin Lee and his team at University of Pennsylvania evaluated the benefits and drawbacks of this approach. In short summary, dual coverage including vancomycin did not reduce the rate of infection when compared to cefazolin alone [8]; rather, doing so resulted in an increased risk of developing kidney injury. Our intentions are good; the impulse to look for new and better ways to prevent infection—which causes so Note from the Editor-In-Chief: In ‘‘Editor’s Spotlight,’’ one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present ‘‘Take Five,’’ in which the editor goes behind the discovery with a oneon-one interview with an author of the article featured in ‘‘Editor’s Spotlight.’’ The author certifies that he, or any members of his immediate family, 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. 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 comment refers to the article available at: DOI: 10.1007/s11999-014-4062-3. M. D. Wongworawat MD (&) Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19013, USA e-mail: mwongworawat@clinorthop.org Editor’s Spotlight/Take 5 Published online: 25 April 2015 The Association of Bone and Joint Surgeons1 2015