Feder OI, Yeroushalmi D, Lin CC, et al. - Often, patients undergoing total hip or knee arthroplasty are administered vancomycin as antimicrobial prophylaxis. In order to avoid associated side effects of vancomycin, longer infusion times are required. Researchers herein tested their hypotheses that vancomycin infusion is often initiated too late, and that delayed infusion may increase the risk of surgical site infections and prosthetic joint infections among patients. Clinical data were reviewed identifying 1,047 primary THA and TKA patients (524 THAs and 523 TKAs) who were administered IV vancomycin as primary perioperative gram positive antibiotic prophylaxis. IV vancomycin usage was observed in correlation with following indications: allergy (61%), MRSA colonization (17%), both allergy and colonization (14%), and other (8%). Infusion began > 30 minutes preoperatively in 50.4% of patients, and < 30 minutes preoperatively in 49.6%. Findings suggest that vancomycin is often initiated too late and is linked with elevated rates of infectious causes for readmission and PJI. Based on findings, they emphasize development of preoperative protocols to ensure appropriate vancomycin administration when indicated.