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Clinical Orthopaedics and Related Research®

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01.12.2011 | Clinical Research

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

verfasst von: Koji Yamada, MD, Kunihiro Matsumoto, PhD, Fumiaki Tokimura, MD, Hiroshi Okazaki, MD, PhD, Sakae Tanaka, MD, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2011

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Abstract

Background

Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified.

Questions/purposes

We asked whether 2 g of cefazolin would enable effective serum and bone concentrations relative to the current minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus.

Patients and Methods

We enrolled 43 patients (THA, n = 16; TKA, n = 27) scheduled for primary THAs and primary TKAs. Subjects were given 2 g of cefazolin intravenously before incision. One blood sample and two bone samples were collected from each subject before tourniquet deflation before any additional dose. All samples were assayed at the same laboratory. Minimum inhibitory concentration values were defined based on nationwide surveys.

Results

Mean (± standard deviation) serum concentration was 170.3 ± 51.3 μg/mL (range, 99.3–370.3 μg/mL). Mean bone concentration was 32.3 ± 15.2 μg/g (range, 11.4–70.0 μg/g) in THA, and 16.0 ± 10.4 μg/g (range, 6.3–46.3 μg/g) in TKA. All serum and bone concentrations exceeded the minimum inhibitory concentration for methicillin-sensitive S. aureus, but some serum levels were marginal and no bone levels exceeded the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus.

Conclusions

Our data suggest intravenous administration of 2 g of cefazolin achieves the minimum inhibitory concentration for methicillin-sensitive S. aureus in serum and bone, but not the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus in bone, resulting in a potential risk of deep surgical site infections in THAs and TKAs.

Bannister GC, Auchincloss JM, Johnson DP, Newman JH. The timing of tourniquet application in relation to prophylactic antibiotic administration. J Bone Joint Surg Br. 1988;70:322–324.PubMed

Bernard L, Sadowski C, Monin D, Stern R, Wyssa B, Rohner P, Lew D, Hoffmeyer P. The value of bacterial culture during clean orthopedic surgery: a prospective study of 1,036 patients. Infect Control Hosp Epidemiol. 2004;25:512–514.PubMedCrossRef

Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–1715.PubMedCrossRef

Chang Y, Shih HN, Chen DW, Lee MS, Ueng SW, Hsieh PH. The concentration of antibiotic in fresh-frozen bone graft. J Bone Joint Surg Br. 2010;92:1471–1474.PubMedCrossRef

Chin NX, Neu NM, Neu HC. Activity of cephalosporins against coagulase-negative staphylococci. Diagn Microbiol Infect Dis. 1990;13:67–69.PubMedCrossRef

Cunha BA, Gossling HR, Pasternak HS, Nightingale CH, Quintiliani R. The penetration characteristics of cefazolin, cephalothin, and cephradine into bone in patients undergoing total hip replacement. J Bone Joint Surg Am. 1977;59:856–859.PubMed

Dalstrom DJ, Venkatarayappa I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ. Time-dependent contamination of opened sterile operating-room trays. J Bone Joint Surg Am. 2008;90:1022–1025.PubMedCrossRef

Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.PubMedCrossRef

Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 2007;89:1605–1618.PubMedCrossRef

10.

Forse RA, Karam B, MacLean LD, Christou NV. Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery. 1989;106:750–756; discussion 756–757.PubMed

11.

Friedman RJ, Friedrich LV, White RL, Kays MB, Brundage DM, Graham J. Antibiotic prophylaxis and tourniquet inflation in total knee arthroplasty. Clin Orthop Relat Res. 1990;260:17–23.PubMed

12.

Friedrich LV, White RL, Brundage DM, Kays MB, Friedman RJ. The effect of tourniquet inflation on cefazolin tissue penetration during total knee arthroplasty. Pharmacotherapy. 1990;10:373–377.PubMed

13.

Fujimura T, Yoshida I, Itoh Y, Tachibana M, Kaku M, Kanemitsu K, Takahashi C, Shiotani J, Ono Y, Baba H, Matsuo S, Asari S, Matsuoka K, Kusano N, Nose M, Saikawa T, Hiramatsu K, Kohno S, Hirakata Y, Yamane N, Nakasone I, Yamano Y. [Antimicrobial susceptibility of clinical isolates of aerobic Gram-positive cocci and anaerobic bacteria in 2004][in Japanese]. Jpn J Chemother. 2008;56:543–561.

14.

Garza-Gonzalez E, Morfin-Otero R, Llaca-Diaz JM, Rodriguez-Noriega E. Staphylococcal cassette chromosome mec (SCC mec) in methicillin-resistant coagulase-negative staphylococci: a review and the experience in a tertiary-care setting. Epidemiol Infect. 2010;138:645–654.PubMedCrossRef

15.

Irie S, Terakawa M, Ishibashi K, Tabata K, Suzuki S, Yokota Y. [Pharmacokinetic study of a parenteral cephalosporin, cefazolin in healthy volunteers given Cefamezin® -infusion 1-g kit][in Japanese]. Kagakuryouhou no Ryouiki. 1999;15:766–774.

16.

Johnson DP. Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee. J Bone Joint Surg Br 1987;69:787–789.PubMed

17.

Kimura Y, Nagano K, Higashiyama I, Jinushi Y, Sasaki S, Yoshida I. [Surveillance of susceptibility of clinical isolates of various bacterial species to antibacterial agents -No.1 against Gram-positive cocci isolated in 1994][in Japanese]. Jpn J Chemother. 1996;44:595–609.

18.

Kimura Y, Yoshida I, Higashiyama I, Nagano K, Sasaki S. [Surveillance of susceptibility of clinical isolates of various bacterial species to antibacterial agents -No.1 against Gram-positive cocci isolated in 1996][in Japanese]. Jpn J Chemother. 1998;46:324–342.

19.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–278; quiz 279–280.PubMedCrossRef

20.

Moran E, Masters S, Berendt AR, McLardy-Smith P, Byren I, Atkins BL. Guiding empirical antibiotic therapy in orthopaedics: the microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007;55:1–7.PubMedCrossRef

21.

Nickinson RS, Board TN, Gambhir AK, Porter ML, Kay PR. The microbiology of the infected knee arthroplasty. Int Orthop. 2010;34:505–510.PubMedCrossRef

22.

Oliveira AD, d’Azevedo PA, de Sousa LB, Viana-Niero C, Francisco W, Lottenberg C, Martino MD, Hofling-Lima AL. Laboratory detection methods for methicillin resistance in coagulase negative Staphylococcus isolated from ophthalmic infections. Arq Bras Oftalmol. 2007;70:667–675.PubMedCrossRef

23.

Osmon DR. Antimicrobial resistance: guidelines for the practicing orthopaedic surgeon. Instr Course Lect. 2002;51:527–537.PubMed

24.

Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am. 2005;87:980–985.PubMedCrossRef

25.

Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008;16:283–293.PubMed

26.

Quintiliani R, Nightingale C. Principles of antibiotic usage. Clin Orthop Relat Res. 1984;190:31–35.PubMed

27.

Raad I, Alrahwan A, Rolston K. Staphylococcus epidermidis: emerging resistance and need for alternative agents. Clin Infect Dis. 1998;26:1182–1187.PubMedCrossRef

28.

Rafiq I, Gambhir AK, Wroblewski BM, Kay PR. The microbiology of infected hip arthroplasty. Int Orthop. 2006;30:532–535.PubMedCrossRef

29.

Saegeman V, Lismont D, Verduyckt B, Ectors N, Stuyck J, Verhaegen J. Antimicrobial susceptibility of coagulase-negative staphylococci on tissue allografts and isolates from orthopedic patients. J Orthop Res. 2007;25:501–507.PubMedCrossRef

30.

Savitz SI, Savitz MH, Goldstein HB, Mouracade CT, Malangone S. Topical irrigation with polymyxin and bacitracin for spinal surgery. Surg Neurol. 1998;50:208–212.PubMedCrossRef

31.

Schurman DJ, Hirshman HP, Kajiyama G, Moser K, Burton DS. Cefazolin concentrations in bone and synovial fluid. J Bone Joint Surg Am. 1978;60:359–362.PubMed

32.

Sørensen TS, Colding H, Schroeder E, Rosdahl VT. The penetration of cefazolin, erythromycin and methicillin into human bone tissue. Acta Orthop Scand. 1978;49:549–553.PubMedCrossRef

33.

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol. 2002;23:183–189.PubMedCrossRef

34.

Wikler MA, Cockerill FR, Craig WA, Dudley MN, Eliopoulos GM, Hecht DW, Hindler JF, Low DE, Sheehan DJ, Tenover FC, Turnidge JD, Weinstein MP, Zimmer BL, Ferraro MJ, Swenson JM. Performance Standards for Antimicrobial Susceptibility Testing; Fifteenth Informational Supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2005.

35.

Williams DN, Gustilo RB, Beverly R, Kind AC. Bone and serum concentrations of five cephalosporin drugs: relevance to prophylaxis and treatment in orthopedic surgery. Clin Orthop Relat Res. 1983;179:253–265.PubMedCrossRef

36.

World Health Organization. WHO Guidelines for Safe Surgery: 2009: Safe Surgery Saves Lives. Available at: http://whqlibdoc.who.int/publications/2009/9789241598552_eng.pdf. Accessed November 18, 2010.

37.

Yamada K, Okazaki H, Iga T, Nagai I, Tatsumi T, Touhara C, Sato W, Hasegawa J, Tanaka S, Matsudaira K, Nakamura K. [The surgical site is contaminated even in the clean orthopaedic surgery][in Japanese]. Nippon Seikeigeka Gakkai Zasshi. 2010;84:S707.

38.

Yoshida I, Kimura Y, Higashiyama I, Sugimori G, Yamano Y. [Surveillance of susceptibility of clinical isolates of various bacterial species to antibacterial agents: antimicrobial activity against gram-positive cocci and anaerobic bacteria isolated in 2000][in Japanese]. Jpn J Chemother. 2003;51:179–208.

Titel: Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?
verfasst von: Koji Yamada, MD
Kunihiro Matsumoto, PhD
Fumiaki Tokimura, MD
Hiroshi Okazaki, MD, PhD
Sakae Tanaka, MD, PhD
Publikationsdatum: 01.12.2011
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 12/2011
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2111-8

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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?