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Comparison of Routine Prophylaxis With Vancomycin or Cefazolin for Femoral Neck Fracture Surgery: Microbiological and Clinical Outcomes

Published online by Cambridge University Press:  21 June 2016

Jacques Merrer ,
Laetitia Desbouchages ,
Valérie Serazin ,
Jimmy Razafimamonjy ,
François Pauthier  and
Michel Leneveu
Jacques Merrer*
Affiliation:
Infection Control Unit, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
Laetitia Desbouchages
Affiliation:
Department of Public Health, the Bacteriology Laboratory, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
Valérie Serazin
Affiliation:
Molecular Biology Laboratory, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
Jimmy Razafimamonjy
Affiliation:
Medical Information Unit, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
François Pauthier
Affiliation:
Department of Orthopedic Surgery, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
Michel Leneveu
Affiliation:
Department of Public Health, the Bacteriology Laboratory, Centre Hospitalier de Poissy / St Germain-en-Laye, Poissy, France
*
Unité de Lutte Contre les Infections Nosocomiales, Hôpital de Poissy / St Germain-en-Laye, 10 Rue du Champ-Gaillard, 78303 Poissy, France (jmerrer@chi-poissy-st-germain.fr)
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Abstract

Objective.

To assess the impact of antibiotic prophylaxis on the emergence of vancomycin-resistant strains of Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus and the incidence of surgical site infection (SSI) after vancomycin or cefazolin prophylaxis for femoral neck fracture surgery.

Design.

Prospective cohort study.

Setting.

A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage.

Patients.

All patients admitted with a femoral neck fracture from March 1, 2004 through February 28, 2005 were prospectively identified and screened for MRSA and vancomycin-resistant (VRE) carriage at admission and at day 7. Deep incisional and organ/space SSIs were also recorded.

Results.

Of 263 patients included in the study, 152 (58%) received cefazolin and 106 (40%) received vancomycin. At admission, the prevalence of MRSA carriage was 6.8%; it was 12% among patients with risk factors and 2.2% among patients with no risk factors (P = .002). At day 7 after surgery, there were 6 patients (2%) who had hospital-acquired MRSA, corresponding to 0.7% in the cefazolin group and 5% in the vancomycin group (P = .04); none of the MRSA isolates were resistant to glycopeptides. The rate of VRE carriage at admission was 0.4%. Three patients (1%) had acquired carriage of VRE (1 had E. faecium and 2 had E. faecalis); all 3 were in the cefazolin group (2% of patients) and none in the vancomycin group (P = .27). Eight SSIs (3%) occurred, 4% in the cefazolin group and 2% in the vancomycin group (P = .47).

Conclusions.

This preliminary study demonstrates that cefazolin and vancomycin prophylaxis have similar impacts on the emergence of glycopeptide-resistant pathogens. Neither MRSA infection nor increased rates of SSI with other bacteria were observed in the vancomycin group, suggesting that a larger multicenter study should be initiated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1366 - 1371
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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