Cefazolin should be administered maximum 30min before incision in total knee arthroplasty when tourniquet is used

Bićanić, Goran; Crnogaća, Krešimir; Barbarić, Katarina; Delimar, Domagoj

doi:10.1016/j.mehy.2014.03.020

Cited by 12 publications

(9 citation statements)

References 33 publications

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“…Cefazolin, a β -lactam antibiotic and a first-generation cephalosporin, is effective against gram-positive bacteria (e.g., staphylococci, streptococci), some gram-negative bacteria ( Escherichia coli and Klebsiella pneumoniae ) and is on the World Health Organization's List of Essential Medicines (19th list, April 2015). It achieves highest peak bone concentrations of all first-generation cephalosporins 40 min after parenteral application with a serum half-life of 108 min and bone half-life of 42 min [ 3 ]. It is 90% bactericidal to S. aureus at concentrations greater than 100 μ g/mL and eliminates bacteria within 48 h at concentrations of 250 μ g/mL or within 24 h at 500 μ g/mL [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…In orthopaedic surgery, antibiotics are applied to significantly reduce the incidence of infection and osteomyelitis [ 1 , 2 ]. Cefazolin is a first-generation cephalosporin, which is used as a single-shot parenteral antibiotic or is locally applied in bone cement during orthopaedic surgery [ 3 , 4 ]. It is a β -lactam antibiotic, which inhibits cell wall synthesis of the bacteria.…”

Section: Introductionmentioning

confidence: 99%

“…Although cefazolin is the most commonly used antibiotic drug in arthroplasty antibiotic prophylaxis worldwide [ 3 , 14 ], there exist only a few reports of how it affects human osteoblasts and its progenitor cells and, therefore, how it may affect postoperative bone healing [ 15 , 16 ]. There are several reports that antibiotic drugs have a significant effect on osteoblasts.…”

Section: Introductionmentioning

confidence: 99%

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Cefazolin Irreversibly Inhibits Proliferation and Migration of Human Mesenchymal Stromal Cells

Pilge

Fröbel

Lensing‐Höhn

et al. 2016

BioMed Research International

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Drugs may have a significant effect on postoperative bone healing by reducing the function of human mesenchymal stromal cells (hMSC) or mature osteoblasts. Although cefazolin is one of the most commonly used antibiotic drugs in arthroplasty to prevent infection worldwide, there is a lack of information regarding how cefazolin affects hMSC and therefore may have an effect on early bone healing. We studied the proliferation and migration capacity of primary hMSC during cefazolin treatment at various doses for up to 3 days, as well as the reversibility of the effects during the subsequent 3 days of culture without the drug. We found a time- and dose-dependent reduction of the proliferation rate and the migratory potential. Tests of whether these effects were reversible revealed that doses ≥250 μg/mL or treatments longer than 24 h irreversibly affected the cells. We are the first to show that application of cefazolin irreversibly inhibits the potential of hMSC for migration to the trauma site and local proliferation. Cefazolin should be administered only at the required dosage and time to prevent periprosthetic infection. If long-term administration is required and delayed bone healing is present, cefazolin application must be considered as a cause of delayed bone healing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cefazolin Irreversibly Inhibits Proliferation and Migration of Human Mesenchymal Stromal Cells

Pilge

Fröbel

Lensing‐Höhn

et al. 2016

BioMed Research International

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“…All patients preoperatively received antibacterial prophylaxis with fi rst-generation cephalosporins or clindamycin, which is in accordance with recent guidelines 7,8 . A thigh tourniquet was infl ated at 250-300 mm Hg before the beginning of surgery.…”

Section: Methodsmentioning

confidence: 99%

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty

Mihaljević¹

2016

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SUMMARY -Fondaparinux has been shown to be as eff ective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. Th e main goal of this prospective randomized controlled trial was to defi ne whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) infl uences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the fi rst 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation of the edema during the early postoperative period. No diff erences were found between the groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. Th e level of urea was signifi cantly lower in the nadroparin group on the fi rst and second postoperative day. No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were noted during the study. Study results showed both fondaparinux and nadroparin to have the same infl uence on clinical parameters during the fi rst 7 postoperative days in patients undergoing TKA.

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“…Although potentially beneficial as a prophylaxis against infection, these remnant concentrations of antibiotics in bone allografts can cause allergic reaction in sensitive patients. In orthopaedic surgery the first choice antibiotics for prophylaxis are cephalosporins, especially cefazolin [17,18]. IgE-mediated hypersensitivity reactions have been reported with the use of cephalosporins, as a cross-reaction between different cephalosporins or as a cross-reaction to other b-lactam antibiotics, namely, penicillin [19][20][21].…”

Section: Evaluation Of Hypothesismentioning

confidence: 99%

Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients

2015

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Cefazolin should be administered maximum 30min before incision in total knee arthroplasty when tourniquet is used

Cited by 12 publications

References 33 publications

Cefazolin Irreversibly Inhibits Proliferation and Migration of Human Mesenchymal Stromal Cells

Cefazolin Irreversibly Inhibits Proliferation and Migration of Human Mesenchymal Stromal Cells

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty

Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients

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