Doctors typically give the antibiotic cefazolin to people who have knee and hip replacements in order to prevent infection. Some physicians have debated if adding another antibiotic — vancomycin — would be helpful to avoid infections. A new study finds that adding vancomycin didn’t prevent infections. In fact, it may have led to more adverse reactions and infections in people who took it when they had the surgery.
The study, a double-blind, superiority, placebo-controlled trial that looked at data from people who took antibiotics and had hip or knee surgeries in Australia, was published Wednesday in the New England Journal of Medicine. Many people recovering from joint replacements receive short-term rehab in skilled nursing facilities.
Doctors have debated whether or not to add vancomycin in surgical patients to prevent infection. But the increase in antibiotic resistant bacteria has left them in need of a definitive verdict. In Australia, many medical facilities give cefazolin and vancomycin to people who had knee or hip surgeries — without knowing if doing so was truly beneficial.
Vancomycin is commonly used for methicillin resistant Staphylococcus aureus (MRSA), which is also known as “golden Staph.”
The researchers examined data from 4,239 people who didn’t have a history of MRSA. The study participants were in 11 hospitals across Australia. The people all received cefazolin. Then they were put into two groups; they either got vancomycin or a placebo. The infection rate in the vancomycin group was 5.7%; it was 3.7% in the placebo group.
“Given the number of joint replacements performed in Australia and globally, our trial has answered the important [question] about whether more antibiotics are better for our patients having joint replacement surgery: with the definitive answer being ‘no.’ This trial will have a significant impact on practice,” Trisha Peel, from the Monash University Central Clinical School, said in a statement.
“A lot of things seem to make sense, but we don’t really know for sure until they are tested in a clinical trial,” Peel said. “This is one of those cases — more antibiotics weren’t better, and in some people might have actually been worse.”
Post-surgical infections are rare, and affect anywhere from 1% to 5% of people who undergo the operations, according to the statement.
