In adult patients without known methicillin-resistant Staphylococcus aureus (MRSA) colonization who were undergoing arthroplasty, the addition of vancomycin 1.5 g to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections, researchers report. “The results of subgroup analyses suggested a possible increased risk of surgical-site infection in knee arthroplasty with the addition of vancomycin on secondary analysis,” the authors write. “Vancomycin prophylaxis was associated with an increased risk of hypersensitivity reactions and a decreased risk of acute kidney injury.”
The primary outcome of the multicenter, double-blind, superiority, placebo-controlled trial was surgical-site infection within 90 days after surgery. Results were as follows: “A total of 4,239 patients underwent randomization. Among 4,113 patients in the modified intention-to-treat population (2,233 undergoing knee arthroplasty, 1,850 undergoing hip arthroplasty, and 30 undergoing shoulder arthroplasty), surgical-site infections occurred in 91 of 2,044 patients (4.5%) in the vancomycin group and in 72 of 2,069 patients (3.5%) in the placebo group (relative risk, 1.28; 95% confidence interval [CI], 0.94 to 1.73; P = 0.11). Among patients undergoing knee arthroplasty, surgical-site infections occurred in 63 of 1,109 patients (5.7%) in the vancomyin group and in 42 of 1,124 patients (3.7%) in the placebo group (relative risk, 1.52; 95% CI, 1.04 to 2.23). Among patients undergoing hip arthroplasty, surgical-site infections occurred in 28 of 920 patients (3.0%) in the vancomycin group and in 29 of 930 patients (3.1%) in the placebo group (relative risk, 0.98; 95% CI, 0.59 to 1.63). Adverse events occurred in 35 of 2,010 patients (1.7%) in the vancomycin group and in 35 of 2,030 patients (1.7%) in the placebo group, including hypersensitivity reactions in 24 of 2,010 patients (1.2%) and 11 of 2,030 patients (0.5%), respectively (relative risk, 2.20; 95% CI, 1.08 to 4.49), and acute kidney injury in 42 of 2,010 patients (2.1%) and 74 of 2,030 patients (3.6%), respectively (relative risk, 0.57; 95% CI, 0.39 to 0.83).”