Guidelines for Complications of Cancer Treatment Vol VIII Part B

(cefazolin or cefuroxime) or penicillin (nafcillin oroxacillin) compounds versus vancomycin forprevention of infections associated with surgicalimplants.b. A high frequency of MRSA infection in aninstitution is an indication for the use ofvancomycin for prophylaxis 7 . Wiesel and Esterhai 8recommend administration of vancomycin ininstitutions where the prevalence of MRSA isgreater than 10% to 20%. There is no consensusabout what constitutes a high prevalence ofmethicillin resistance, however, and no evidencethat routine use of vancomycin for prophylaxis ininstitutions with perceived high risk of MRSAinfection results in fewer surgical site infectionsthan the use of cefazolin 9 .c. Vancomycin is appropriate for surgical prophylaxisfor patients with known MRSA colonization 9 .3. Teicoplanin has proved to be an effective and safeprophylactic agent in prosthetic implant surgeryespecially when there is a high risk of infection withMRSA 10-14 . It is not available in the United States.Restricted use is advised to prevent antibiotic resistantstrains. For surgical procedures requiring a tourniquet,such as total knee arthroplasty, regional administrationof a single dose of teicoplanin achieved a highconcentration in the operative field, and resulted in arate of postoperative infection similar to those ofconventional prophylactic regimens 15 .4. The use of daptomycin for prophylaxis in orthopedicsurgery needs to be investigated.5. Antimicrobial prophylaxis with third- and fourthgenerationcephalosporins is not indicated, because most125