PROPHYLAXIS AGAINST INFECTION IN TOTAL JOINT ARTHROPLASTY - ONE-DAY OF CEFUROXIME COMPARED WITH 3 DAYS OF CEFAZOLIN

The efficacy of cefuroxime was compared with the efficacy of cefazolin for prophylaxis against postoperative wound infection in a prospectiv e, double-blind, multicenter study of 1354 patients who had had electi ve primary or revision total hip or knee arthroplasty. The patients we re randomly assigned to receive either 1.5 grams of cefuroxime followe d by 750 milligrams eight and sixteen hours later (for a total of one day of antibiotic treatment), or one gram of cefazolin every eight hou rs for nine doses (for a total of three days of antibiotic treatment). The first dose of each drug was administered fifteen to sixty minutes before the operative incision was made (for a primary operation) or a fter tissue samples had been Obtained for culture (for a revision proc edure). After the operation, the patients were assessed daily while ho spitalized and then at two to three months and one year after the oper ation. Demographic characteristics and risk factors were similar in th e two groups. For the patients who had had a primary hip arthroplasty, the rate of deep wound infection was 0.5 per cent (one of 187) for th ose who had received cefuroxime and 1.2 per cent (two of 168) for thos e who had received cefazolin. For the patients who had had a primary k nee arthroplasty, the rate of deep wound infection was 0.6 per cent (o ne of 178) for those who had received cefuroxime and 1.4 per cent (thr ee of 207) for those who had received cefazolin. No evidence of a supe rficial or deep wound infection was observed in 97 per cent of the pat ients who had received either cefuroxime or cefazolin and who met the criteria for evaluation (p = 0.76). Staphylococcus aureus and Staphylo coccus epidermidis were the most frequently isolated pathogens. There was no significant difference in the prevalence of wound infections be tween the patients who had received a one-day regimen of cefuroxime an d those who had received a three-day regimen of cefazolin.