Major study in the use of antibiotics with joint replacement

Picture caption: L-R - Prof Richard de Steiger, Keisha Cabahug and Rhea Alcordo from the ASAP Trial Team at Epworth Richmond.

A major Australian study involving Epworth HealthCare patients, has researched the use of antibiotics in joint replacement surgery that could lead to changes in medical practice around the world.

More than 106,000 hip and knee replacements are performed by orthopaedic surgeons in Australia each year. A small number of patients contract infections and they must undergo a second operation.

Patients are routinely given the antibiotic Cefazolin to reduce post-surgery infections. However, a rise in bugs resistant to Cefazolin has seen some surgeons give patients a second antibiotic, Vancomycin, which is commonly used to treat golden staph infections.

The ASAP trial led by Professor Trish Peel, an Epworth Richmond Infectious Diseases physician, involved 4,200 hip and knee replacement patients, including 645 who had surgery at Epworth Richmond.

The study observed patients, who were administered both Cefazolin and Vancomycin, to determine whether infections can be further reduced in the first 90 days after surgery.

Prof Richard de Steiger, Epworth Victor Smorgon Chair of Surgery, University of Melbourne, and Orthopaedic Surgeon led the study at Epworth Richmond.

He said the study found Vancomycin shouldn’t routinely be given to patients undergoing knee and hip replacements.

“The key finding from this research is the addition of Vancomycin does not reduce joint replacement infection,” Professor de Steiger said.

“This is important as many hospitals around the world use Vancomycin as an additional surgical antibiotic. This raises major concerns about the potential for antibiotic resistance in primary joint replacements.”

The study results were published in the peer reviewed New England Journal of Medicine.