title: Prospective randomized double-blinded trial comparing 2 anti-MRSA agents with supplemental coverage of cefazolin before lower extremity revascularization.
abstract: OBJECTIVE
  To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion.
  
  
  BACKGROUND
  Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections?
  
  
  METHODS
  Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days.
  
  
  RESULTS
  Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in 1(1.18%)/0(0%) of Vancomycin patients and 9 (9.68%)/1 (1.08%) of Daptomycin patients, respectively (P < 0.02 and P = 1.00). Readmissions related to surgical site infections occurred in 4(4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (P = 0.11). Patients undergoing operative exploration occurred in 5 (5.88%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (P = 0.17). Late infections were reported in 3 patients, 2 of which were in the combined Daptomycin group. Median hospital charges related to readmissions due to a surgical site infection was $50,823 in the combination Vancomycin arm and $110,920 in the combination Daptomycin group; however, no statistical significance was appreciated (P = 0.11).
  
  
  CONCLUSIONS
  Vancomycin supplemental prophylaxis seems to reduce the incidence of Gram-positive infection compared with adding supplemental Daptomycin prophylaxis. The Incidence of MRSA-related surgical site infections is low with the addition of either anti-MRSA agents compared with historical incidence of MRSA-related infection.
authors.affiliation: *Department of Surgery, Division of Vascular and Endovascular Surgery, West Virginia University: Charleston Division, Charleston, WV †Charleston Area Medical Center: CAMC Institute, Charleston, WV.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.forename: James R
authors.initials: JR
authors.lastname: Campbell
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hass
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjundappa
authors.forename: Mohit
authors.initials: M
authors.lastname: Srivastiva
authors.forename: Asmita
authors.initials: A
authors.lastname: Modak
authors.forename: Mary
authors.initials: M
authors.lastname: Emmett
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage; D016009:Chi-Square Distribution; D017576:Daptomycin / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D061214:Patient Safety; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
chemical_list: D014640:Vancomycin; D002437:Cefazolin; D017576:Daptomycin