Abstract
Background. Total hip replacement (THR) has become the ideal treatment for any disorder causing joint destruction. Surgery-related infections are reported only in 1–2 % of THR, but antibiotic prophylaxis is necessary because infections are associated with significant morbidity and occasionally death. 1st and 2nd –generation cephalosporin or, in hospital with methicillin-R Staphylococcus spp (MRSA, MRSE) high prevalence, vancomycin, are the most frequently drug emplojed. The most frequent side effects of antibiotic prophylaxis are allergic reaction and pseudomembranous enterocolitis.
The objective of the present study was to assess the efficacy and tolerability of antibiotic prophylaxis for THR at S. Corona Hospital Pietra Ligure SV (Italy).
In our hospital the majority of prostethic device infections are due to MRSA, but recently we have described increment of infection due to Pseudomonas spp and other gram-. For this reason we used association of vancomycin plus pefloxacin in primary prophylaxis.
Methods. Retrospective analysis of 1118 THR performed in the period 2003–2004, receiving surgical prophylaxis with a single dose of the association vancomycin 1000 mg plus pefloxacin 400 mg. Data collection regarded patients’ age at surgery and reasons for THR. The presence of a surgery-related infection was investigated by means of a phone interview about the function of the hip device (presence of pain, deambulation impairment, fever). Patients with pain or other problems were submitted to physical exam, laboratory tests, plain radiograph and if necessary to exclude of infection, radioisotopic scans.
Results. We report the preliminary data on 218 THR in 211 patients (81 M, 122 F, median age 67.49 aa, range 29–91). THR was performed for: osteoarthrites in 168 cases, trauma in 26, osteonecrosis in 9, displasia in 4 cases, previous osteotomy in 4. 167/211 patients were submitted to a phone interview and 44 to a clinical examination.
Conclusions. In our center, the association of vancomycin-pefloxacin resulted effective and well tolerated as single dose prophylaxis for THR.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
