LRH a significant contributor to major antibiotic study

Latrobe Regional Health (LRH) has been a major contributor to a clinical trial which has found less is
more when it comes to patients using antibiotics at the time of having hip and knee surgery.

The ASAP trial – or Australian Surgical Antibiotic Prophylaxis- trial aimed to discover whether adding
additional antibiotics at the time of surgery would help prevent infections such as golden Staph.

But the trial found current best practice is the way to go, because adding a second antibiotic called
vancomycin did not reduce infection rates, compared to the use of a single antibiotic called
cefazolin.

The study determined when all the data from patients was analysed, the outcome following the
addition of vancomycin was no better than the use of the traditional cefazolin antibiotic alone.

And in those patients having a knee replacement, the incidence of infection was slightly higher when
adding vancomycin, but researchers are yet to find out why.
These findings were recently published in one of the world’s most respected medical publications,
the New England Journal of Medicine.

LRH played a significant role in the three-year trial, having recruited 369 patients out of the 4113
participants across 11 hospitals in Victoria, NSW and Queensland.

LRH principal investigator Dr Peter Rehfisch said this trial was made possible because hundreds of
patients in Gippsland, and thousands in Australia, agreed to be part of “history-making” research.

“Post-operative infection is one of the most serious complications that occurs in a small number of
patients having a hip or knee replacement,” Dr Rehfisch said.

“This trial was designed to see whether we could find good evidence that we could reduce the
likelihood of infection occurring by changing the current antibiotic treatment.”

“But the results do suggest the single antibiotic that is currently used for infection prevention in
Australia in this type of surgery appears to be the safest and most effective option.”

More than 65,000 knee and 53,000 hip joint replacements were performed in Australia in 2022, and
with an ageing population, this is projected to exceed 250,000 each year by 2030, according to
Monash University.

Monash University Central Clinical School and ASAP study lead Professor Trisha Peel said this
reflected the importance of large, randomised, multi-centre clinical trials.

Dr Peel said the trial would have a “significant impact” on practice.

“A lot of things seem to make sense, but we don’t really know for sure until they are tested in a
clinical trial.” Prof Peel said.

“This is one of those cases. More antibiotics weren’t better, and in some people, they might have
actually been worse.”

The ASAP trial is now closed at LRH but the hospital has opened several other trials investigating
research questions in the hope of improving, or confirming best care practices.