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Postoperative surgical-site infection — particularly deep incisional or periprosthetic infection — is a dreaded complication after total knee arthroplasty (TKA) or total hip arthroplasty (THA). To lower risk for this complication, perioperative administration of cefazolin is standard practice. To examine whether adding vancomycin would confer additional benefit (by covering methicillin-resistant Staphylococcus aureus [MRSA] and methicillin-resistant S. epidermidis), Australian researchers conducted this randomized trial.
About 4000 patients — roughly half undergoing TKA and half undergoing THA — received cefazolin plus either vancomycin or placebo, shortly before skin incision. At 90 days, the overall incidence of any surgical-site infection…