Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-07

AUTHORS

Timothy L. Tan, Bryan D. Springer, John A. Ruder, Michael R. Ruffolo, Antonia F. Chen

ABSTRACT

BACKGROUND: Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. QUESTIONS/PURPOSES: (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy? METHODS: We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between β-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. RESULTS: After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI, 0.10-0.62]; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI, 0.01-0.88]; p = 0.038). Vancomycin also demonstrated an increased risk of Gram-negative infection in bivariate analysis (OR, 2.42 [CI, 1.01-5.82]; p = 0.049) compared to cefazolin. CONCLUSIONS: With the numbers available, vancomycin alone during elective primary TJA does not seem to result in a higher rate of subsequent deep SSI. However, patients who received vancomycin alone demonstrated reduced odds of Gram-positive organisms and methicillin-resistant Staphylococcus aureus. Vancomycin monotherapy can be used without increasing the risk of deep SSI; however, it should only be used in patients who require vancomycin, eg, anaphylactic reactions to penicillin resulting from the potential for the emergence of organism resistance and nephrotoxicity. Future studies are needed that use registry and large database studies to refute or confirm the preliminary findings of this study and determine if vancomycin monotherapy influences the risk of periprosthetic joint infection. LEVEL OF EVIDENCE: Level III, therapeutic study. More... »

PAGES

1601-1606

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11999-015-4672-4

DOI

http://dx.doi.org/10.1007/s11999-015-4672-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1025756342

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26689584


Indexing Status Check whether this publication has been indexed by Scopus and Web Of Science using the SN Indexing Status Tool
Incoming Citations Browse incoming citations for this publication using opencitations.net

JSON-LD is the canonical representation for SciGraph data.

TIP: You can open this SciGraph record using an external JSON-LD service: JSON-LD Playground Google SDTT

[
  {
    "@context": "https://springernature.github.io/scigraph/jsonld/sgcontext.json", 
    "about": [
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/1103", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Clinical Sciences", 
        "type": "DefinedTerm"
      }, 
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/11", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Medical and Health Sciences", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Aged", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Anti-Bacterial Agents", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Antibiotic Prophylaxis", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Arthroplasty, Replacement", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Cefazolin", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Cross Infection", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Drug Administration Schedule", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Drug Hypersensitivity", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Female", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Humans", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Logistic Models", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Male", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Middle Aged", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Multivariate Analysis", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "North Carolina", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Odds Ratio", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Penicillins", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Philadelphia", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Protective Factors", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Retrospective Studies", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Risk Assessment", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Risk Factors", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Surgical Wound Infection", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Time Factors", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Treatment Outcome", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Vancomycin", 
        "type": "DefinedTerm"
      }
    ], 
    "author": [
      {
        "affiliation": {
          "alternateName": "Thomas Jefferson University", 
          "id": "https://www.grid.ac/institutes/grid.265008.9", 
          "name": [
            "Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Tan", 
        "givenName": "Timothy L.", 
        "id": "sg:person.01103301641.41", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01103301641.41"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "OrthoCarolina", 
          "id": "https://www.grid.ac/institutes/grid.418446.b", 
          "name": [
            "OrthoCarolina, Charlotte, NC, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Springer", 
        "givenName": "Bryan D.", 
        "id": "sg:person.01231726624.06", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01231726624.06"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "OrthoCarolina", 
          "id": "https://www.grid.ac/institutes/grid.418446.b", 
          "name": [
            "OrthoCarolina, Charlotte, NC, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Ruder", 
        "givenName": "John A.", 
        "id": "sg:person.014077443323.12", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.014077443323.12"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "OrthoCarolina", 
          "id": "https://www.grid.ac/institutes/grid.418446.b", 
          "name": [
            "OrthoCarolina, Charlotte, NC, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Ruffolo", 
        "givenName": "Michael R.", 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "Thomas Jefferson University", 
          "id": "https://www.grid.ac/institutes/grid.265008.9", 
          "name": [
            "Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Chen", 
        "givenName": "Antonia F.", 
        "id": "sg:person.0720501031.10", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.0720501031.10"
        ], 
        "type": "Person"
      }
    ], 
    "citation": [
      {
        "id": "https://doi.org/10.1002/jor.22549", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1002096357"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.arth.2011.03.044", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1011529868"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1086/605593", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1012385427"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/0021-9681(87)90171-8", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1020988115"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "sg:pub.10.1007/s11999-012-2255-1", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1024095772", 
          "https://doi.org/10.1007/s11999-012-2255-1"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1007/s11999-012-2255-1", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1024095772"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1007/s11999-012-2255-1", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1024095772"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.arth.2012.03.040", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1025869441"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1067/mtc.2002.119698", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1028764631"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/s1081-1206(10)62466-0", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1030993384"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.arth.2010.01.105", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1031521144"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.amjsurg.2005.01.015", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1042842159"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1001/archinte.162.7.822", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1049908466"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.amjmed.2005.10.052", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1050626598"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1111/j.1398-9995.1994.tb00809.x", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1051534928"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.2106/jbjs.m.00663", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1068903536"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.2106/jbjs.m.00663", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1068903536"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.2106/jbjs.m.00663", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1068903536"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://app.dimensions.ai/details/publication/pub.1078990362", 
        "type": "CreativeWork"
      }
    ], 
    "datePublished": "2016-07", 
    "datePublishedReg": "2016-07-01", 
    "description": "BACKGROUND: Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy.\nQUESTIONS/PURPOSES: (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy?\nMETHODS: We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between \u03b2-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin.\nRESULTS: After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI, 0.10-0.62]; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI, 0.01-0.88]; p = 0.038).\u00a0Vancomycin also demonstrated an increased risk of Gram-negative infection in bivariate analysis (OR, 2.42 [CI, 1.01-5.82]; p\u00a0=\u00a00.049) compared to cefazolin.\nCONCLUSIONS: With the numbers available, vancomycin alone during elective primary TJA does not seem to result in a higher rate of subsequent deep SSI. However, patients who received vancomycin alone demonstrated reduced odds of Gram-positive organisms and methicillin-resistant Staphylococcus aureus. Vancomycin monotherapy can be used without increasing the risk of deep SSI; however, it should only be used in patients who require vancomycin, eg, anaphylactic reactions to penicillin resulting from the potential for the emergence of organism resistance and nephrotoxicity. Future studies are needed that use registry and large database studies to refute or confirm the preliminary findings of this study and determine if vancomycin monotherapy influences the risk of periprosthetic joint infection.\nLEVEL OF EVIDENCE: Level III, therapeutic study.", 
    "genre": "research_article", 
    "id": "sg:pub.10.1007/s11999-015-4672-4", 
    "inLanguage": [
      "en"
    ], 
    "isAccessibleForFree": true, 
    "isPartOf": [
      {
        "id": "sg:journal.1007212", 
        "issn": [
          "0009-921X", 
          "1528-1132"
        ], 
        "name": "Clinical Orthopaedics and Related Research\u00ae", 
        "type": "Periodical"
      }, 
      {
        "issueNumber": "7", 
        "type": "PublicationIssue"
      }, 
      {
        "type": "PublicationVolume", 
        "volumeNumber": "474"
      }
    ], 
    "name": "Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?", 
    "pagination": "1601-1606", 
    "productId": [
      {
        "name": "readcube_id", 
        "type": "PropertyValue", 
        "value": [
          "7ab4c93f2dc0c6333a71294ce142b3b289c0dd2b68f5b1742e320262efe80775"
        ]
      }, 
      {
        "name": "pubmed_id", 
        "type": "PropertyValue", 
        "value": [
          "26689584"
        ]
      }, 
      {
        "name": "nlm_unique_id", 
        "type": "PropertyValue", 
        "value": [
          "0075674"
        ]
      }, 
      {
        "name": "doi", 
        "type": "PropertyValue", 
        "value": [
          "10.1007/s11999-015-4672-4"
        ]
      }, 
      {
        "name": "dimensions_id", 
        "type": "PropertyValue", 
        "value": [
          "pub.1025756342"
        ]
      }
    ], 
    "sameAs": [
      "https://doi.org/10.1007/s11999-015-4672-4", 
      "https://app.dimensions.ai/details/publication/pub.1025756342"
    ], 
    "sdDataset": "articles", 
    "sdDatePublished": "2019-04-11T10:03", 
    "sdLicense": "https://scigraph.springernature.com/explorer/license/", 
    "sdPublisher": {
      "name": "Springer Nature - SN SciGraph project", 
      "type": "Organization"
    }, 
    "sdSource": "s3://com-uberresearch-data-dimensions-target-20181106-alternative/cleanup/v134/2549eaecd7973599484d7c17b260dba0a4ecb94b/merge/v9/a6c9fde33151104705d4d7ff012ea9563521a3ce/jats-lookup/v90/0000000347_0000000347/records_89824_00000001.jsonl", 
    "type": "ScholarlyArticle", 
    "url": "https://link.springer.com/10.1007%2Fs11999-015-4672-4"
  }
]
 

Download the RDF metadata as:  json-ld nt turtle xml License info

HOW TO GET THIS DATA PROGRAMMATICALLY:

JSON-LD is a popular format for linked data which is fully compatible with JSON.

curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1007/s11999-015-4672-4'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1007/s11999-015-4672-4'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1007/s11999-015-4672-4'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1007/s11999-015-4672-4'


 

This table displays all metadata directly associated to this object as RDF triples.

251 TRIPLES      21 PREDICATES      71 URIs      47 LITERALS      35 BLANK NODES

Subject Predicate Object
1 sg:pub.10.1007/s11999-015-4672-4 schema:about N0129a1b3e5a5435186aa0c529aab5385
2 N0df8b28618354ec2ac015becee468624
3 N187a2cfbc1474b30928da056f9fd999d
4 N3724bb8c4b55466b9d07225e1f2ffe66
5 N38b926308e20434ebd0b2dbdc5044f0e
6 N3913266ef41c4189a3fd6505f9aec728
7 N452c06232793423ebcd6a8190c39d5d1
8 N4793aa8d251345f9a159d83adce4b512
9 N49c24f29f3744a9084e136ab1deeec5b
10 N5f19e9e02a8d494082a7d9de17219580
11 N665b35f953e04e58a04984950093fc7d
12 N765e835505b94cbea7c6a9a62bc12dbc
13 N76dd5a44dad24a18bbb8307b3ba3378a
14 N80210d8b1cb045c6978f046a3fab9e49
15 N810d947996e04586889455611cb9b689
16 N8c5576fea5734891a86ef87654af171a
17 N92a5be43625d435694161e1ca8f5b1a6
18 Na0fcdff01dc34ed4abc28de401f77f68
19 Na87eb9fd9ed3472e9bd195e1bda9e6eb
20 Nc243db11812a4d85b890bec9c7574a70
21 Nd66c6ac735cb4ba185ea440560ed0b31
22 Nd7395bbbca514e9c9e4bebe42c357845
23 Nde0d37d911b9421883454a0e127591d4
24 Ne2d3eedb012244179ae1fd12c18df8f5
25 Nf3e52e63a09a4ef08902387a08a9d37e
26 Nfa958cd058694017a0438952c647dc61
27 anzsrc-for:11
28 anzsrc-for:1103
29 schema:author Nb2c302e5ac7045cfb0194aae7b92ae90
30 schema:citation sg:pub.10.1007/s11999-012-2255-1
31 https://app.dimensions.ai/details/publication/pub.1078990362
32 https://doi.org/10.1001/archinte.162.7.822
33 https://doi.org/10.1002/jor.22549
34 https://doi.org/10.1007/s11999-012-2255-1
35 https://doi.org/10.1016/0021-9681(87)90171-8
36 https://doi.org/10.1016/j.amjmed.2005.10.052
37 https://doi.org/10.1016/j.amjsurg.2005.01.015
38 https://doi.org/10.1016/j.arth.2010.01.105
39 https://doi.org/10.1016/j.arth.2011.03.044
40 https://doi.org/10.1016/j.arth.2012.03.040
41 https://doi.org/10.1016/s1081-1206(10)62466-0
42 https://doi.org/10.1067/mtc.2002.119698
43 https://doi.org/10.1086/605593
44 https://doi.org/10.1111/j.1398-9995.1994.tb00809.x
45 https://doi.org/10.2106/jbjs.m.00663
46 schema:datePublished 2016-07
47 schema:datePublishedReg 2016-07-01
48 schema:description BACKGROUND: Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. QUESTIONS/PURPOSES: (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy? METHODS: We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between β-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. RESULTS: After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI, 0.10-0.62]; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI, 0.01-0.88]; p = 0.038). Vancomycin also demonstrated an increased risk of Gram-negative infection in bivariate analysis (OR, 2.42 [CI, 1.01-5.82]; p = 0.049) compared to cefazolin. CONCLUSIONS: With the numbers available, vancomycin alone during elective primary TJA does not seem to result in a higher rate of subsequent deep SSI. However, patients who received vancomycin alone demonstrated reduced odds of Gram-positive organisms and methicillin-resistant Staphylococcus aureus. Vancomycin monotherapy can be used without increasing the risk of deep SSI; however, it should only be used in patients who require vancomycin, eg, anaphylactic reactions to penicillin resulting from the potential for the emergence of organism resistance and nephrotoxicity. Future studies are needed that use registry and large database studies to refute or confirm the preliminary findings of this study and determine if vancomycin monotherapy influences the risk of periprosthetic joint infection. LEVEL OF EVIDENCE: Level III, therapeutic study.
49 schema:genre research_article
50 schema:inLanguage en
51 schema:isAccessibleForFree true
52 schema:isPartOf N4ab970d55375486588e56055bd26f741
53 N933a80a891ce422baf7c7805ff0aaa6b
54 sg:journal.1007212
55 schema:name Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?
56 schema:pagination 1601-1606
57 schema:productId N15e8cf8974434bddaef356e58bb2fe11
58 N2cc7cd3670184e56a1b53b9768a7ffd6
59 N43a8318a9b9240c6a58e6f44355d44c0
60 N650333a7acad42f6a5461da7d70e43d5
61 Nd9809974ebe24f61b7672d8cd672ebdc
62 schema:sameAs https://app.dimensions.ai/details/publication/pub.1025756342
63 https://doi.org/10.1007/s11999-015-4672-4
64 schema:sdDatePublished 2019-04-11T10:03
65 schema:sdLicense https://scigraph.springernature.com/explorer/license/
66 schema:sdPublisher Na66f657d7cf944688629d86b13f66ee7
67 schema:url https://link.springer.com/10.1007%2Fs11999-015-4672-4
68 sgo:license sg:explorer/license/
69 sgo:sdDataset articles
70 rdf:type schema:ScholarlyArticle
71 N0129a1b3e5a5435186aa0c529aab5385 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
72 schema:name Antibiotic Prophylaxis
73 rdf:type schema:DefinedTerm
74 N0df8b28618354ec2ac015becee468624 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
75 schema:name Drug Administration Schedule
76 rdf:type schema:DefinedTerm
77 N15e8cf8974434bddaef356e58bb2fe11 schema:name doi
78 schema:value 10.1007/s11999-015-4672-4
79 rdf:type schema:PropertyValue
80 N187a2cfbc1474b30928da056f9fd999d schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
81 schema:name Female
82 rdf:type schema:DefinedTerm
83 N2548ebadd04546bfbe2b990e9ff82df7 rdf:first sg:person.0720501031.10
84 rdf:rest rdf:nil
85 N2cc7cd3670184e56a1b53b9768a7ffd6 schema:name nlm_unique_id
86 schema:value 0075674
87 rdf:type schema:PropertyValue
88 N3724bb8c4b55466b9d07225e1f2ffe66 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
89 schema:name Cross Infection
90 rdf:type schema:DefinedTerm
91 N38b926308e20434ebd0b2dbdc5044f0e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
92 schema:name Risk Factors
93 rdf:type schema:DefinedTerm
94 N3913266ef41c4189a3fd6505f9aec728 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
95 schema:name Cefazolin
96 rdf:type schema:DefinedTerm
97 N43a8318a9b9240c6a58e6f44355d44c0 schema:name pubmed_id
98 schema:value 26689584
99 rdf:type schema:PropertyValue
100 N452c06232793423ebcd6a8190c39d5d1 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
101 schema:name Risk Assessment
102 rdf:type schema:DefinedTerm
103 N4793aa8d251345f9a159d83adce4b512 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
104 schema:name Philadelphia
105 rdf:type schema:DefinedTerm
106 N49c24f29f3744a9084e136ab1deeec5b schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
107 schema:name Protective Factors
108 rdf:type schema:DefinedTerm
109 N4ab970d55375486588e56055bd26f741 schema:issueNumber 7
110 rdf:type schema:PublicationIssue
111 N5a27bde2d7c643f990242ca62e940e79 rdf:first sg:person.01231726624.06
112 rdf:rest N5c30199de71448de8039b730143f5e9c
113 N5c30199de71448de8039b730143f5e9c rdf:first sg:person.014077443323.12
114 rdf:rest Nb34c3f223d12494990f1f9334f81c9f7
115 N5f19e9e02a8d494082a7d9de17219580 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
116 schema:name Penicillins
117 rdf:type schema:DefinedTerm
118 N650333a7acad42f6a5461da7d70e43d5 schema:name dimensions_id
119 schema:value pub.1025756342
120 rdf:type schema:PropertyValue
121 N665b35f953e04e58a04984950093fc7d schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
122 schema:name Treatment Outcome
123 rdf:type schema:DefinedTerm
124 N73160b40228e45a38a18abc32555676a schema:affiliation https://www.grid.ac/institutes/grid.418446.b
125 schema:familyName Ruffolo
126 schema:givenName Michael R.
127 rdf:type schema:Person
128 N765e835505b94cbea7c6a9a62bc12dbc schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
129 schema:name Anti-Bacterial Agents
130 rdf:type schema:DefinedTerm
131 N76dd5a44dad24a18bbb8307b3ba3378a schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
132 schema:name Retrospective Studies
133 rdf:type schema:DefinedTerm
134 N80210d8b1cb045c6978f046a3fab9e49 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
135 schema:name Middle Aged
136 rdf:type schema:DefinedTerm
137 N810d947996e04586889455611cb9b689 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
138 schema:name Male
139 rdf:type schema:DefinedTerm
140 N8c5576fea5734891a86ef87654af171a schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
141 schema:name Aged
142 rdf:type schema:DefinedTerm
143 N92a5be43625d435694161e1ca8f5b1a6 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
144 schema:name Time Factors
145 rdf:type schema:DefinedTerm
146 N933a80a891ce422baf7c7805ff0aaa6b schema:volumeNumber 474
147 rdf:type schema:PublicationVolume
148 Na0fcdff01dc34ed4abc28de401f77f68 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
149 schema:name North Carolina
150 rdf:type schema:DefinedTerm
151 Na66f657d7cf944688629d86b13f66ee7 schema:name Springer Nature - SN SciGraph project
152 rdf:type schema:Organization
153 Na87eb9fd9ed3472e9bd195e1bda9e6eb schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
154 schema:name Logistic Models
155 rdf:type schema:DefinedTerm
156 Nb2c302e5ac7045cfb0194aae7b92ae90 rdf:first sg:person.01103301641.41
157 rdf:rest N5a27bde2d7c643f990242ca62e940e79
158 Nb34c3f223d12494990f1f9334f81c9f7 rdf:first N73160b40228e45a38a18abc32555676a
159 rdf:rest N2548ebadd04546bfbe2b990e9ff82df7
160 Nc243db11812a4d85b890bec9c7574a70 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
161 schema:name Multivariate Analysis
162 rdf:type schema:DefinedTerm
163 Nd66c6ac735cb4ba185ea440560ed0b31 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
164 schema:name Odds Ratio
165 rdf:type schema:DefinedTerm
166 Nd7395bbbca514e9c9e4bebe42c357845 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
167 schema:name Drug Hypersensitivity
168 rdf:type schema:DefinedTerm
169 Nd9809974ebe24f61b7672d8cd672ebdc schema:name readcube_id
170 schema:value 7ab4c93f2dc0c6333a71294ce142b3b289c0dd2b68f5b1742e320262efe80775
171 rdf:type schema:PropertyValue
172 Nde0d37d911b9421883454a0e127591d4 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
173 schema:name Surgical Wound Infection
174 rdf:type schema:DefinedTerm
175 Ne2d3eedb012244179ae1fd12c18df8f5 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
176 schema:name Vancomycin
177 rdf:type schema:DefinedTerm
178 Nf3e52e63a09a4ef08902387a08a9d37e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
179 schema:name Arthroplasty, Replacement
180 rdf:type schema:DefinedTerm
181 Nfa958cd058694017a0438952c647dc61 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
182 schema:name Humans
183 rdf:type schema:DefinedTerm
184 anzsrc-for:11 schema:inDefinedTermSet anzsrc-for:
185 schema:name Medical and Health Sciences
186 rdf:type schema:DefinedTerm
187 anzsrc-for:1103 schema:inDefinedTermSet anzsrc-for:
188 schema:name Clinical Sciences
189 rdf:type schema:DefinedTerm
190 sg:journal.1007212 schema:issn 0009-921X
191 1528-1132
192 schema:name Clinical Orthopaedics and Related Research®
193 rdf:type schema:Periodical
194 sg:person.01103301641.41 schema:affiliation https://www.grid.ac/institutes/grid.265008.9
195 schema:familyName Tan
196 schema:givenName Timothy L.
197 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01103301641.41
198 rdf:type schema:Person
199 sg:person.01231726624.06 schema:affiliation https://www.grid.ac/institutes/grid.418446.b
200 schema:familyName Springer
201 schema:givenName Bryan D.
202 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01231726624.06
203 rdf:type schema:Person
204 sg:person.014077443323.12 schema:affiliation https://www.grid.ac/institutes/grid.418446.b
205 schema:familyName Ruder
206 schema:givenName John A.
207 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.014077443323.12
208 rdf:type schema:Person
209 sg:person.0720501031.10 schema:affiliation https://www.grid.ac/institutes/grid.265008.9
210 schema:familyName Chen
211 schema:givenName Antonia F.
212 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.0720501031.10
213 rdf:type schema:Person
214 sg:pub.10.1007/s11999-012-2255-1 schema:sameAs https://app.dimensions.ai/details/publication/pub.1024095772
215 https://doi.org/10.1007/s11999-012-2255-1
216 rdf:type schema:CreativeWork
217 https://app.dimensions.ai/details/publication/pub.1078990362 schema:CreativeWork
218 https://doi.org/10.1001/archinte.162.7.822 schema:sameAs https://app.dimensions.ai/details/publication/pub.1049908466
219 rdf:type schema:CreativeWork
220 https://doi.org/10.1002/jor.22549 schema:sameAs https://app.dimensions.ai/details/publication/pub.1002096357
221 rdf:type schema:CreativeWork
222 https://doi.org/10.1007/s11999-012-2255-1 schema:sameAs https://app.dimensions.ai/details/publication/pub.1024095772
223 rdf:type schema:CreativeWork
224 https://doi.org/10.1016/0021-9681(87)90171-8 schema:sameAs https://app.dimensions.ai/details/publication/pub.1020988115
225 rdf:type schema:CreativeWork
226 https://doi.org/10.1016/j.amjmed.2005.10.052 schema:sameAs https://app.dimensions.ai/details/publication/pub.1050626598
227 rdf:type schema:CreativeWork
228 https://doi.org/10.1016/j.amjsurg.2005.01.015 schema:sameAs https://app.dimensions.ai/details/publication/pub.1042842159
229 rdf:type schema:CreativeWork
230 https://doi.org/10.1016/j.arth.2010.01.105 schema:sameAs https://app.dimensions.ai/details/publication/pub.1031521144
231 rdf:type schema:CreativeWork
232 https://doi.org/10.1016/j.arth.2011.03.044 schema:sameAs https://app.dimensions.ai/details/publication/pub.1011529868
233 rdf:type schema:CreativeWork
234 https://doi.org/10.1016/j.arth.2012.03.040 schema:sameAs https://app.dimensions.ai/details/publication/pub.1025869441
235 rdf:type schema:CreativeWork
236 https://doi.org/10.1016/s1081-1206(10)62466-0 schema:sameAs https://app.dimensions.ai/details/publication/pub.1030993384
237 rdf:type schema:CreativeWork
238 https://doi.org/10.1067/mtc.2002.119698 schema:sameAs https://app.dimensions.ai/details/publication/pub.1028764631
239 rdf:type schema:CreativeWork
240 https://doi.org/10.1086/605593 schema:sameAs https://app.dimensions.ai/details/publication/pub.1012385427
241 rdf:type schema:CreativeWork
242 https://doi.org/10.1111/j.1398-9995.1994.tb00809.x schema:sameAs https://app.dimensions.ai/details/publication/pub.1051534928
243 rdf:type schema:CreativeWork
244 https://doi.org/10.2106/jbjs.m.00663 schema:sameAs https://app.dimensions.ai/details/publication/pub.1068903536
245 rdf:type schema:CreativeWork
246 https://www.grid.ac/institutes/grid.265008.9 schema:alternateName Thomas Jefferson University
247 schema:name Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
248 rdf:type schema:Organization
249 https://www.grid.ac/institutes/grid.418446.b schema:alternateName OrthoCarolina
250 schema:name OrthoCarolina, Charlotte, NC, USA
251 rdf:type schema:Organization
 




Preview window. Press ESC to close (or click here)


...