Trial of Vancomycin and Cefazolin as Surgical Prophylaxis

To the Editor: In their multicenter, phase 4, randomized, controlled trial, Peel et al. (Oct. 19 issue)(1) showed that preoperative vancomycin provided no additive benefit as compared with cefazolin prophylaxis alone for the prevention of surgical-site infection within 90 days after total joint arthroplasty. We want to underline the fact that more than 75% of the trial participants underwent preoperative screening for methicillin-resistant Staphylococcus aureus (MRSA), and those with known MRSA colonization were primarily excluded. This characteristic of the trial potentially impairs the generalizability of the findings, because MRSA screening and decolonization protocols vary substantially among countries.(2,3) Therefore, despite the . . .