Joint revision surgery

  • hip

  • knee

  • elbow

  • ankle

  • shoulder

Note: withholding prophylactic antibiotic prior to revision arthroplasty is not recommended unless there is a high suspicion of infection and pre-op cultures are negative or not obtained

- 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.

 

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