Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes.
ABSTRACT 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.
Prospective cohort study.
A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage.
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.
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).
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.
SourceAvailable from: Javad Parvizi
Article: Perioperative Antibiotics.The Journal of arthroplasty 12/2013; DOI:10.1016/j.arth.2013.09.030 · 2.37 Impact Factor
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ABSTRACT: Prophylactic antibiotics are effective in reducing the rate of surgical site infection (SSI). Cephalosporin antibiotics are recommended except for patients colonised with meticillin resistant staphylococcus aureus (MRSA), where glycopeptide antibiotics are indicated. However, in the trauma setting, the MRSA status is unknown prior to surgery.Aim: To determine if the incidence of MRSA colonisation in trauma patients from long term care (LTC) warrants the use of empirical glycopeptide antibiotics.Methods: A retrospective analysis of patients admitted with hip fractures was performed. The MRSA status of patient from LTC facilities and home was determined.Results: The prevalence of MRSA colonisation in patients admitted from LTC facilities was 33.6%, compared to 3.6% for patients admitted from home, P < 0.001.Our results suggest that risk of patients carrying MRSA is significantly higher for patients being admitted form LTC. This group of patients may benefit from empirical glycopeptide antibiotic when the MRSA status is unknown.Journal of Infection Prevention 09/2010; 11(5):161-165. DOI:10.1177/1757177410375487
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ABSTRACT: Abstract In peripheral vascular surgery, cephalosporins are nowadays regarded,as the first choice for operative antibiotic prophylaxis. We have recently observed changes in colonizing patterns, pathogen prevalence,and,antibiotic,susceptibility,to antimicrobials. Multiresistant pathogens,are becoming,more,frequent in vascular surgical wound infections, showing regional and local variations as to prophylactic antibiotic susceptibility. Data from the available literature so far have shown,no strong evidence for a change in routine surgical antibiotic prophylaxis. We must,consider regional and institutional prevalence,of pathogen,resistance and,patterns,of antibiotic susceptibility to establish specific guidelines for the use of alternativeJornal Vascular Brasileiro 01/2007; 6(4). DOI:10.1590/S1677-54492007000400012