An Australian study reveals that prescribing a combination of antibiotics to patients undergoing joint replacement surgery is ineffective in preventing postoperative infections.
It also has the potential to exacerbate the looming threat of superbugs, experts say.
The global surge in knee and hip joint replacements, driven primarily by an ageing population, has prompted medical professionals to explore innovative strategies for preventing infections.
It was widely believed that combining the antibiotic cefazolin with vancomycin, a potent antibiotic typically used to combat ‘golden staph’ or MRSA (Methicillin-resistant Staphylococcus aureus), could offer enhanced protection against surgical infections.
However, the Australian Surgical Antibiotic Prophylaxis (ASAP) trial, led by Professor Trisha Peel, an infectious diseases clinician affiliated with Monash University, has debunked this notion.
The study examined 4,239 joint replacement patients across 11 Australian hospitals, randomly assigning them either cefazolin in conjunction with vancomycin or a placebo.
Post-surgery infections have been a persistent concern, affecting up to 3% of joint replacement patients, leading to substantial patient suffering and additional surgeries.
In some tragic cases, this included fatalities.
Furthermore, the economic costs associated with these infections have been substantial.
The trial results revealed that vancomycin, when administered alongside cefazolin, did not offer any significant protection against infections.
In fact, patients undergoing knee joint replacement surgery who received vancomycin were found to have a higher infection rate of 5.7%, compared to the 3.7% infection rate in the placebo group.
Professor Peel emphasised the need to re-evaluate antibiotic practices in surgery, highlighting the importance of preserving antibiotics as a vital resource.
Cautioning against the inappropriate and unnecessary use of antibiotics and citing the risk of serious, life-threatening allergic reactions such as anaphylaxis associated with vancomycin, she said: ‘Given the number of joint replacements performed in Australia and globally, our trial has answered the importance of whether more antibiotics are better for our patients having joint replacement surgery: with the definitive answer being "no". This trial will have a significant impact on practice.’
Professor Jonathan Iredell, an infectious diseases physician and clinical microbiologist at the University of Sydney, echoed the significance of this study in maintaining high standards in modern healthcare.
He stressed the need to continually refine common hospital protocols to ensure the best possible patient outcomes.
The global increase in knee and hip replacements, especially in the US, where the number of patients needing joint replacements is projected to exceed 2.7 million in the next seven years, underscores the urgency of finding effective infection prevention strategies. While post-surgery infections remain relatively rare at 1-5%, they have a significant impact on patient morbidity and mortality.
The study’s findings have profound implications for the medical community as healthcare providers grapple with the challenge of balancing infection prevention with the growing threat of antibiotic resistance.
