WEDNESDAY, Oct. 18, 2023 (HealthDay News) — The addition of vancomycin to cefazolin prophylaxis is not superior to placebo for prevention of surgical site infections in patients undergoing arthroplasty, according to a study published in the Oct. 19 issue of the New England Journal of Medicine.

Trisha N. Peel, M.B., B.S., Ph.D., from Monash University in Melbourne, Australia, and colleagues conducted a multicenter, superiority, placebo-controlled trial in which adult patients without known methicillin-resistant Staphylococcus aureus (MRSA) colonization who were undergoing arthroplasty were randomly assigned to receive 1.5 g vancomycin or normal saline placebo in addition to cefazolin prophylaxis. The modified intention-to-treat analysis included 4,113 patients: 2,233 undergoing knee arthroplasty; 1,850 undergoing hip arthroplasty; and 30 undergoing shoulder arthroplasty.

The researchers found that surgical site infections occurred in 4.5 and 3.5 percent of patients in the vancomycin and placebo groups, respectively, among the modified intention-to-treat population (relative risk, 1.28; 95 percent confidence interval, 0.94 to 1.73; P = 0.11). Surgical site infection occurred in 5.7 and 3.7 percent of patients in the vancomycin and placebo groups, respectively, among those undergoing knee arthroplasty (relative risk, 1.52; 95 percent confidence interval, 1.04 to 2.23). For those undergoing hip arthroplasty, the corresponding proportions were 3.0 and 3.1 percent (relative risk, 0.98; 95 percent confidence interval, 0.59 to 1.63). Adverse events occurred in 1.7 percent of patients in both the vancomycin group and the placebo group.

“In this pragmatic, randomized trial involving adult patients undergoing arthroplasty who had a low prevalence of MRSA colonization, the addition of vancomycin was not superior to surgical antimicrobial prophylaxis with cefazolin,” the authors write.

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