Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty

This multicenter, double-blind, placebo-controlled trial assessed the efficacy of adding vancomycin to cefazolin prophylaxis in arthroplasty among adult patients without known MRSA colonization. A total of 4239 patients were randomized; 4113 were included in the modified intention-to-treat population. Surgical-site infections (SSIs) occurred in 4.5% of the vancomycin group versus 3.5% of the placebo group (RR 1.28; P=0.11), with no overall superiority demonstrated. Knee arthroplasty patients showed a higher SSI rate with vancomycin (5.7%) than placebo (3.7%). Vancomycin was associated with increased hypersensitivity reactions (1.2% vs 0.5%) and reduced acute kidney injury (2.1% vs 3.6%). MRSA prevalence was low, and most infections were caused by methicillin-susceptible S. aureus. The study concludes vancomycin added to cefazolin does not improve SSI prevention in non-MRSA arthroplasty patients and may increase adverse events.

This multicenter, double-blind, placebo-controlled trial assessed the efficacy of adding vancomycin to cefazolin prophylaxis in arthroplasty among adult patients without known MRSA colonization. A total of 4239 patients were randomized; 4113 were included in the modified intention-to-treat population. Surgical-site infections (SSIs) occurred in 4.5% of the vancomycin group versus 3.5% of the placebo group (RR 1.28; P=0.11), with no overall superiority demonstrated. Knee arthroplasty patients showed a higher SSI rate with vancomycin (5.7%) than placebo (3.7%). Vancomycin was associated with increased hypersensitivity reactions (1.2% vs 0.5%) and reduced acute kidney injury (2.1% vs 3.6%). MRSA prevalence was low, and most infections were caused by methicillin-susceptible S. aureus. The study concludes vancomycin added to cefazolin does not improve SSI prevention in non-MRSA arthroplasty patients and may increase adverse events.