medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2024, Number 3

<< Back Next >>

Acta Ortop Mex 2024; 38 (3)

Intraosseous vancomycin in total knee arthroplasty

Martínez W, Tillet F, Bochatey E, Lopreite F

Language: Spanish
References: 27
Page: 172-178
PDF size: 245.29 Kb.


ABSTRACT

Introduction: intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA). Material and methods: a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII). Results: in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII. Conclusions: IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.


REFERENCES

  1. Upadhyyaya G. Tewari S. Enhancing surgical outcomes: a critical review of antibiotic prophylaxis in orthopedic surgery. Cureus. 2023; 15(10): e47828. doi: 10.7759/cureus.47828.

  2. Peel TN, Astbury S, Cheng AC, Paterson DL, Buising KL, Spelman T, et al. Trial of vancomycin and cefazolin as surgical prophylaxis in arthroplasty. N Engl J Med. 2023; 389(16): 1488-98. doi: 10.1056/NEJMoa2301401.

  3. Weiser MC, Moucha CS. The current state of screening and decolonization for the prevention of Staphylococcus aureus surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am. 2015; 97: 1449-58. doi: 10.2106/JBJS.N.01114.

  4. Kim T, Kandiah S, Patel M, Rab S, Wong J, Xue W, et al. Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Notes. 2015; 8: 579 doi: 10.1186/s13104-015-1518-9.

  5. Brandariz Núñez D, Guarc Prades E, García Navarro B, Picón Herrera R, Hernandez Corredoira V. Pancitopenia induced by vancomicina: case report. Farm Hosp. 2018; 42(1): 31-2. doi: 10.7399/fh.10886.

  6. Southorn P, Plevak D, Wright A, Wilson J. Adverse effects of vancomycin administered in the perioperative period. Mayo Clin Proc. 2006; 61(9): 721-4. doi: 10.1016/s0025-6196(12)62773-6.

  7. Garey KW, Dao T, Chen H, Amrutkar P, Kumar N, Reiter M, et al. Timing of vancomycin prophylaxis for cardiac surgery patients and the risk of surgical site infections. J Antimicrob Chemother. 2006; 58(3): 645-50. doi: 10.1093/jac/dkl279.

  8. Walsh AL, Fields AC, Dieterich JD, Chen DD, Bronson MJ, Moucha CS. Risk factors for Staphylococcus aureus nasal colonization in joint arthroplasty patients. J Arthroplasty. 2018; 33: 1530-3. doi: 10.1016/j.arth.2017.12.038.

  9. Campbell KA, Cunningham C, Hasan S, Hutzler L, Bosco JA 3rd. Risk Factors for developing Staphylococcus aureus nasal colonization in spine and arthroplasty surgery. Bull Hosp Jt Dis (2013). 2015; 73(4): 276-81.

  10. Mercado MG, Smith DK, Guard EL. Acute kidney injury: diagnosis and management. Am Fam Physician. 2019; 100(11): 687-94.

  11. Pai MP, Mercier RC, Koster SA. Epidemiology of vancomycin-induced neutropenia in patients receiving home intravenous infusion therapy. Ann Pharmacother. 2006; 40: 224-8. doi 10.1345/aph.1G436.

  12. Ponce B, Raines BT, Reed RD, Vick C, Richman J, Hawn M. Surgical site infection after arthroplasty: comparative effectiveness of prophylactic antibiotics: do surgical care improvement project guidelines need to be updated? J Bone Joint Surg Am. 2014; 96(12): 970-7. doi: 10.2106/JBJS.M.00663.

  13. Young SW, Zhang M, Freeman JT, Vince KG, Coleman B. Higher cefazolin concentrations with intraosseous regional prophylaxis in TKA. Clin Orthop Relat Res. 2013; 471: 244-9.

  14. Mabrouk A, Abouharb A, Stewart G, Palan J, Pandit H. National variation in prophylactic antibiotic use for elective primary total joint replacement. Bone Jt Open. 2023; 4(10): 742-9. doi: 10.1302/2633-1462.410.BJO-2023-0055.R1.

  15. Crawford T, Rodvold KA, Solomkin JS. Vancomycin for surgical prophylaxis? Clin Infect Dis. 2012; 54(10): 1474-9. doi: 10.1093/cid/cis027.

  16. Yamada K, Matsumoto K, Tokimura F, Okazaki H, Tanaka S. Are bone and serum cefazolin concentrations adequate for antimicrobial prophylaxis? Clin Orthop Relat. Res. 2011; 469: 3486-94.

  17. Cunha ML, Rugolo LM, Lopes CA. Study of virulence factors in coagulase-negative staphylococci isolated from newborns. Mem Inst Oswaldo Cruz. 2006; 101(6): 661-8.

  18. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med. 2006; 166: 2138-44.

  19. Larsson AJ, Walker KJ, Raddatz JK, Rotschafer JC. The concentration independent effect of monoexponential and biexponential decay in vancomycin concentrations on the killing of Staphylococcus aureus under aerobic and anaerobic conditions. J Antimicrob Chemother. 1996; 38: 589-97.

  20. Sharareh B, Sutherland C, Pourmand D, Molina N, Nicolau DP, Schwarzkopf R. Effect of body weight on cefazolin and vancomycin trabecular bone concentrations in patients undergoing total joint arthroplasty. Surg Infect (Larchmt). 2016; 17: 71-7.

  21. Graziani AL, Lawson LA, Gibson GA, Steinberg MA, MacGregor RR. Vancomycin concentrations in infected and noninfected human bone. Antimicrob Agents Chemother. 1988; 32: 1320-2.

  22. Young SW, Zhang M, Freeman JT, Mutu-Grigg J, Pavlou P, Moore GA. The Mark Coventry Award: higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial. Clin Orthop Relat Res. 2014; 472: 57-65.

  23. Young SW, Zhang M, Moore GA, Pitto RP, Clarke HD, Spangehl MJ. The John N. Insall Award: Higher tissue concentrations of vancomycin achieved with intraosseous regional prophylaxis in revision TKA: a randomized controlled trial. Clin Orthop Relat Res. 2018; 476: 66-74.

  24. Ravi S, Zhu M, Luey C, Young SW. Antibiotic resistance in early periprosthetic joint infection. ANZ J Surg. 2016; 86: 1014-8.

  25. Yamada K, Matsumoto K, Tokimura F, Okazaki H, Tanaka S. Are bone and serum cefazolin concentrations adequate for antimicrobial prophylaxis? Clin Orthop Relat Res. 2011; 469: 3486-94.

  26. Parkinson B, McEwen P, Wilkinson M, Hazratwala K, Hellman J, Kan H, et al. Intraosseous regional prophylactic antibiotics decrease the risk of prosthetic joint infection in primary TKA: a multicenter study. Clin Orthop Relat Res. 2021; 479(11): 2504-12. doi: 10.1097/CORR.0000000000001919.

  27. Klasan A, Patel CK, Young SW. Intraosseous regional administration of vancomycin in primary total knee arthroplasty does not increase the risk of vancomycin-associated complications. J Arthroplasty. 2021; 36(5): 1633-7. doi: 10.1016/j.arth.2020.12.034.



EVIDENCE LEVEL

IV




2020     |     www.medigraphic.com