Prospective randomized double-blinded trial comparing 2 anti-MRSA agents with supplemental coverage of cefazolin
Patrick A Stone1, Ali F AbuRahma, James R Campbell
1*Department of Surgery, Division of Vascular and Endovascular Surgery, West Virginia University: Charleston Division, Charleston, WV †Charleston Area Medical Center: CAMC Institute, Charleston, WV.
Objective:
To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion.
Background:
Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections?
Methods:
Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days.
Results:
Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in 1(1.18%)/0(0%) of Vancomycin patients and 9 (9.68%)/1 (1.08%) of Daptomycin patients, respectively (P < 0.02 and P = 1.00). Readmissions related to surgical site infections occurred in 4(4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (P = 0.11). Patients undergoing operative exploration occurred in 5 (5.88%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (P = 0.17). Late infections were reported in 3 patients, 2 of which were in the combined Daptomycin group. Median hospital charges related to readmissions due to a surgical site infection was $50,823 in the combination Vancomycin arm and $110,920 in the combination Daptomycin group; however, no statistical significance was appreciated (P = 0.11).
Conclusions:
Vancomycin supplemental prophylaxis seems to reduce the incidence of Gram-positive infection compared with adding supplemental Daptomycin prophylaxis. The Incidence of MRSA-related surgical site infections is low with the addition of either anti-MRSA agents compared with historical incidence of MRSA-related infection.
Insights
Vancomycin prophylaxis significantly reduced Gram-positive infections compared to Daptomycin in vascular surgery patients. While MRSA infections were low with both agents, Vancomycin showed a trend toward fewer Gram-positive surgical site infections.
Area of Science:
- Infectious Diseases
- Vascular Surgery
- Antimicrobial Prophylaxis
Background:
- Current antibiotic prophylaxis for vascular procedures typically uses first-generation cephalosporins.
- There's a noted increase in methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections.
- The study investigates if supplemental anti-MRSA prophylaxis reduces Gram-positive or MRSA infections.
Purpose of the Study:
- To prospectively compare antibiotics with methicillin-resistant microbial coverage.
- To evaluate the efficacy of Vancomycin versus Daptomycin in preventing surgical site infections.
- To assess the impact on Gram-positive and MRSA infections in vascular procedures.
Main Methods:
- Single-center, prospective, double-blind, randomized study (2011-2014).
- 178 patients undergoing lower extremity vascular procedures were evaluated at 90 days.
- Infections were categorized as early (<30 days) and late (>90 days).
Main Results:
- Vancomycin showed a significant reduction in Gram-positive infections (1.18% vs. 9.68%, P < 0.02).
- MRSA infections were low in both groups (0% Vancomycin vs. 1.08% Daptomycin, P = 1.00).
- Readmissions and operative explorations due to SSI were numerically lower in the Vancomycin group.
Conclusions:
- Supplemental Vancomycin prophylaxis appears more effective in reducing Gram-positive infections than Daptomycin.
- Both anti-MRSA agents resulted in a low incidence of MRSA-related surgical site infections.
- Further research may be needed to confirm the observed trends in readmissions and charges.
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