Prophylaxis in orthopaedic implant surgery : should we use a glycopeptide?

Success in orthopaedic implant surgery relies on reducing infection to acceptable levels by antibiotic prophylaxis. This could now be threatened by increasing resistance among the staphylococci. In deciding whether to use a glycopeptide for prophylaxis, several topics need to be considered: what are current orthopaedic infection rates with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE)? What other factors might govern a change to a glycopeptide? Are other additional means of reducing infection now more worthwhile? On page 329 of this issue Periti et al. review the role of teicoplanin in orthopaedic prophylaxis; they show that (as far as the numbers of patients in the quoted trials allow) teicoplanin is as effective as the comparator cephalosporins. The organisms recovered are also reported but their antibiotic sensitivities are not given and the presence or absence of methicillin resistance at the trial centres cannot be determined.