How Effective Is Vancomycin at Preventing Post-Op Infections?

Citing the ongoing scourge of periprosthetic joint infection (PJI) in hip and knee arthroplasty, a team of researchers from the University of Calgary in Canada set out to clear the air on whether topical, intrawound vancomycin is effective.

Their study, “Can Topical Vancomycin Prevent Periprosthetic Joint Infection in Hip and Knee Arthroplasty? A Systematic Review,” appears in the August 2021 edition of Clinical Orthopaedics and Related Research.

Murray T. Wong, M.D., an orthopedic surgeon and co-author, told OTW, “PJI is a common and feared complication which leads surgeons to search for any mitigation strategies available. Topical vancomycin is gaining interest based on literature from spine surgery and other orthopaedic domains. We sought to determine whether the practice was supported by current evidence.”

The researchers searched through 2,408 studies and found 9 to be eligible (3,371 patients). Of the 9, 8 were retrospective, comparative studies and 1 was a prospective, comparative study. The size of the studies ranged from 115 to 1,733 patients (recruited between 2010 and 2017). Two reviewers assessed the quality of the included studies. The researchers used the International Consensus Meeting on PJI definition, followed by the Musculoskeletal Infection Society 2011 definition, to determine the presence of a PJI.

The 3,371 patients receiving vancomycin during a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were compared to 2,884 patients who did not receive the drug.

Dr. Wong told OTW: “We determined that only one of nine studies found a significant benefit with respect to PJI for topical vancomycin, and that there was no difference in overall complication rates in the limited data available thus far.”

“In THA alone, one of five studies found a lower risk of PJI,” wrote the authors. “Again, the remainder of the studies found no difference, and odds ratios ranged widely on either side of the line of no difference, between 0.11 and 2.86 for the five studies. In TKA, none of the seven studies showed an effect of vancomycin on PJI. Of these seven studies, odds ratios were between 0.07 and 1.01.”

The authors caution that the studies were underpowered to detect differences in the types of uncommon complications associated with vancomycin (for example, allergy, ototoxicity, and nephrotoxicity).

“While using topical vancomycin is certainly appealing,” advises Dr. Wong, “surgeons should be cautioned that robust evidence is not yet available prior to widespread adoption of the practice.”