From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For sepsis due to post-operative right hip arthroplasty cellulitis, I recommend empiric treatment with vancomycin (15-20 mg/kg IV every 8-12 hours) plus cefepime (2g IV every 8 hours) or piperacillin-tazobactam (4.5g IV every 6-8 hours). This combination provides coverage against common pathogens including methicillin-resistant Staphylococcus aureus (MRSA), Gram-negative organisms, and anaerobes, as supported by the most recent study on managing Staphylococcus aureus bacteremia 1.
Key Considerations
- Blood cultures and deep tissue cultures from the surgical site should be obtained before starting antibiotics if possible.
- Once culture results and sensitivities are available (typically in 48-72 hours), therapy should be narrowed to target the specific organism.
- For prosthetic joint infections, antibiotics are typically continued for 4-6 weeks.
- Infectious disease consultation is recommended for optimal management, as surgical intervention (debridement, implant removal, or replacement) may be necessary alongside antibiotic therapy.
- The approach should address both the immediate sepsis and the underlying prosthetic joint infection, which requires specialized management due to biofilm formation on the prosthetic material that can reduce antibiotic effectiveness.
Predictors and Outcomes
The incidence of sepsis after revision total hip arthroplasty is significant, with predictors including age, open wounds, COPD, dyspnea, and transfusions, as identified in a recent study 2. The sepsis group had higher adverse outcomes, including a 30-day mortality rate, highlighting the importance of prompt and effective management.
Diagnostic Testing
While erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measurements can be useful, a synovial fluid white blood cell (WBC) count is the best test for identifying persistent infection, with an optimum cutoff of 3528 WBCs/microL, as found in a study on perioperative testing for persistent sepsis following resection arthroplasty of the hip for periprosthetic infection 3.
Management of S. aureus Bacteremia
For Staphylococcus aureus bacteremia, empirical antibiotic treatment should include vancomycin or daptomycin, which are active against MRSA, and once S. aureus susceptibilities are known, MSSA should be treated with cefazolin or an antistaphylococcal penicillin, as recommended in a review on the management of S. aureus bacteremia 1. Source control is a critical component of treating S. aureus bacteremia and may include removal of infected intravascular or implanted devices, drainage of abscesses, and surgical debridement.