ICJR Interviews: What’s the Risk of PJI in Penicillin-Allergic Patients’

    A joint replacement patient who reports having a penicillin allergy usually receives vancomycin as antibiotic prophylaxis instead of the cefozolin due to the risk of cross-reactivity with cephalosporins.

    But vancomycin does not eradicate gram-negative organisms. So how do these patients fare compared with those who receive cefazolin? Are they more likely to develop a periprosthetic joint infection (PJI)?

    Overall, the answer is no: In a study at The Rothman Institute in Philadelphia, Pennsylvania, and OrthoCarolina in Charlotte, North Carolina, the PJI rate was about the same in the vancomycin and cefazolin groups, according to Rothman surgeon Antonia F. Chen, MD, MBA.

    But patients in the vancomycin group were more likely to have gram-negative infections, indicating that vancomycin alone is probably not the best choice for penicillin-allergic patients. Another antibiotic that is active against gram-negative organisms, such as gentamicin, should be added, Dr. Chen said.

    Click the image above to hear Dr. Chen discuss the study, “Vancomycin Administration for Reported Penicillin Allergy Increases Gram Negative Joint Infection” (Poster 178), presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Susan Doan-Johnson; Director and Post Production: Charles J. Maynard