Is it time to include vancomycin for routine perioperative antibiotic prophylaxis in total joint arthroplasty patients?

In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) and overall periprosthetic joint infections (PJI), we switched the perioperative prophylactic antibiotic during total knee arthroplasty and total hip arthroplasty from cefazolin to vancomycin in June 2008. We retrospectively reviewed the total and MRSA PJI in 5036 primary total joint arthroplasties, as well as the cure rate of PJI from January 2006 to June 2008 (Ancef Period) and June 2008 to December 2010 (Vanco Period). With vancomycin, total PJI was significantly reduced (1.0%-0.5%) and MRSA PJI (0.23%-0.07%). Periprosthetic joint infections that occurred were more successfully treated with irrigation and debridement only, not requiring spacer (76.9% vs 22.2%). The use of vancomycin as the perioperative prophylactic antibiotic for primary total joint arthroplasties appeared to be effective in decreasing the rate of PJI and may result, when they occur, in infections with less virulent organisms.