Early surgical site infections in patients undergoing orthopaedic oncologic resection following change in perioperative antibiotic selection: A pre-post intervention study

Background: At our institution, cefepime and vancomycin (FEP/VAN) were historically used for perioperative antimicrobial prophylaxis in malignant musculoskeletal tumor patients; however, prophylaxis was modified to cefazolin and vancomycin (CFZ/VAN) on June 6th, 2015. Due to the paucity of guidance and data, this study was conducted to optimize perioperative antimicrobial prophylaxis and compare early surgical site infection (SSI) rates within this patient population. Methods: This was a single center, pre-post intervention, non-inferiority study. We included orthopedic surgery patients with musculoskeletal tumors who underwent resection and endoprosthetic or allograft replacement and received perioperative antibiotic prophylaxis. Perioperative antimicrobial prophylaxis included FEP/VAN or CFZ/VAN followed by oral antibiotic prophylaxis. The main outcome was the incidence of early culture-proven SSIs occurring within 90 days post-procedure. Results: 75 patients were included in each arm (150 total). Early SSI rates were low (FEP/VAN: 2.67% vs CFZ/ VAN: 5.4%, P = 0.68) with no statistically significant differences. There was not a single independent factor associated with an increased odds of early SSI. Conclusion: This study supports CFZ/VAN as appropriate perioperative antibiotic prophylaxis in this patient population. There was no statistically significant change in SSIs with the change from FEP/VAN. Hospital length of stay differed but did not contribute to increased early SSI development odds.