Joint replacement
- Preoperative assessment of nasal culture for S. aureus carriage should be considered.
If nasal S. aureus (MSSA or MRSA) carrier, suggest intranasal mupirocin 2% bid for 4 days prior to surgery ± chlorhexidine 4% body wash the day prior to surgery.
NB: No evidence of benefit if not nasal S. aureus carrier.
- Vancomycin alone should be restricted to true cefazolin allergy or severe non-IgE mediated reaction as it is associated with a higher frequency of postoperative infections (including Gram positive infections).
- For patients with known MRSA colonization or infection, add vancomycin to surgical prophylaxis regimen.
- Insufficient evidence to recommend use of antibiotic-impregnated bone cement in primary arthroplasties.
Common Pathogens
S. aureus
Coagulase negative Staphylococcus (CoNS)
| Regimen(s) of Choice See General Principles and Pre-Op Antibiotic Administration and Intraoperative Antibiotic Administration | ||
|---|---|---|
| Cefazolin | 2g IV | x 1 pre-op dose |
| If MRSA colonization/past infection, add: | ||
| Vancomycin | 15mg/kg IV | x 1 pre-op dose |
| Alternative Regimens if allergy to cefazolin, or severe non-IgE-mediated reaction to any β-lactam (interstitial nephritis, hepatitis, hemolytic anemia, serum sickness, severe cutaneous reactions [e.g. SJS, TEN, DRESS]) | ||
|---|---|---|
| Clindamycin | 600mg IV | x 1 pre-op dose |
| or | ||
| Vancomycin | 15mg/kg IV | x 1 pre-op dose |