title: Targeted use of vancomycin as perioperative prophylaxis reduces periprosthetic joint infection in revision TKA.
abstract: BACKGROUND
  The role of vancomycin in surgical antimicrobial prophylaxis and high-risk patients who are most likely to benefit remains unclear.
  
  
  OBJECTIVE
  We determined the impact of targeted use of vancomycin on (1) the incidence of periprosthetic joint infection (PJI); and (2) the incidence of PJI from methicillin-resistant organisms in patients undergoing revision total knee arthroplasty (TKA) at our institution.
  
  
  METHODS
  In an effort to reduce PJI rates, we added vancomycin to cefazolin as surgical antimicrobial prophylaxis for patients undergoing revision TKA in October 2010. Internal data indicated a high rate of PJI in revision TKA and in particular PJI resulting from methicillin-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). We retrospectively reviewed infection control surveillance data on 414 revision TKAs performed between July 2008 and June 2012 (fiscal years 2009-2012).
  
  
  RESULTS
  The overall rate of PJI in fiscal years 2009-2010 among 190 patients undergoing revision TKA was 7.89%. After the change in surgical antimicrobial prophylaxis, there was a significant reduction in PJI among patients undergoing revision TKA in fiscal years 2011-2012 to 3.13% (p = 0.046). In particular, we observed a reduction in PJI resulting from methicillin-resistant organisms over this same time period, from 4.21% to 0.89% (p = 0.049).
  
  
  CONCLUSIONS
  Targeted use of vancomycin in patients undergoing revision TKA was effective in reducing the rate of PJI and PJI resulting from methicillin-resistant organisms in an institution with a high baseline rate of PJI due to MRSA and MRSE. Identification of high-risk subgroups of patients within a surgical population can help target infection prevention strategies to those who are most likely to benefit and thus minimize potential risks (eg, selection of resistant organisms, adverse drug events) associated with broader application of such an intervention.
authors: Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors: Catherine
authors: C
authors: Liu
authors: Anthony
authors: A
authors: Kakis
authors: Amy
authors: A
authors: Nichols
authors: Michael D
authors: MD
authors: Ries
authors: Thomas P
authors: TP
authors: Vail
authors: Kevin J
authors: KJ
authors: Bozic
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
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