Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes.
OBJECTIVE
To assess the impact of antibiotic prophylaxis on the emergence of vancomycin-resistant strains of Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus and the incidence of surgical site infection (SSI) after vancomycin or cefazolin prophylaxis for femoral neck fracture surgery.


METHODS
Prospective cohort study.


METHODS
A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage.


METHODS
All patients admitted with a femoral neck fracture from March 1, 2004 through February 28, 2005 were prospectively identified and screened for MRSA and vancomycin-resistant (VRE) carriage at admission and at day 7. Deep incisional and organ/space SSIs were also recorded.


RESULTS
Of 263 patients included in the study, 152 (58%) received cefazolin and 106 (40%) received vancomycin. At admission, the prevalence of MRSA carriage was 6.8%; it was 12% among patients with risk factors and 2.2% among patients with no risk factors (P=.002). At day 7 after surgery, there were 6 patients (2%) who had hospital-acquired MRSA, corresponding to 0.7% in the cefazolin group and 5% in the vancomycin group (P=.04); none of the MRSA isolates were resistant to glycopeptides. The rate of VRE carriage at admission was 0.4%. Three patients (1%) had acquired carriage of VRE (1 had E. faecium and 2 had E. faecalis); all 3 were in the cefazolin group (2% of patients) and none in the vancomycin group (P=.27). Eight SSIs (3%) occurred, 4% in the cefazolin group and 2% in the vancomycin group (P=.47).


CONCLUSIONS
This preliminary study demonstrates that cefazolin and vancomycin prophylaxis have similar impacts on the emergence of glycopeptide-resistant pathogens. Neither MRSA infection nor increased rates of SSI with other bacteria were observed in the vancomycin group, suggesting that a larger multicenter study should be initiated.
Merrer
Jacques
J
Unité de Lutte Contre les Infections Nosocomiales, Hôpital de Poissy / St Germain-en-Laye, Poissy, France. jmerrer@chi-poissy-st-germain.fr
Desbouchages
Laetitia
L
Serazin
Valérie
V
Razafimamonjy
Jimmy
J
Pauthier
François
F
Leneveu
Michel
M
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use; D015331:Cohort Studies; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002437:Cefazolin