Cefuroxime concentrations in the anterior and posterior column of the lumbar spine – an experimental porcine study

Hvistendahl, Magnus A.; Bue, Mats; Hanberg, Pelle; Kaspersen, Alexander Emil; Schmedes, Anne; Stilling, Maiken; Høy, Kristian

doi:10.1016/j.spinee.2022.05.010

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…Previous porcine studies have investigated cefuroxime concentrations in non-instrumented cervical and lumbar vertebral cancellous bone ( 11 , 22 , 23 ). Cefuroxime penetrations were described to be incomplete into both cervical (anterior surgical approach) and lumbar corpus vertebral cancellous bone (posterior surgical approach) with lowest concentrations and shortest T>MIC4 in lumbar vertebral cancellous bone.…”

Section: Discussionmentioning

confidence: 99%

“…Following the study period (8 h), all pigs were killed by an overdose of pentobarbital. With reference to reduction, refinement, and replacement (the 3Rs), different data attained from the same pigs were published recently ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

“…Cefuroxime and meropenem concentrations in dialysates and free concentrations of cefuroxime in plasma were quantified by ultra-high performance liquid chromatography tandem mass spectrometry ( 11 ). For cefuroxime, the intermediate precision for the internal controls were 14.2%, 9.6%, 2.6%, and 3.9% for targets 0.01, 0.05, 5.0, and 10.0 µ g/mL, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study

Hvistendahl

Hanberg

Stilling

et al. 2022

ActaO

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Background and purpose: Minimally invasive spine surgery has continuously evolved for specific surgical procedures and patient populations to lower morbidity and the risk of postoperative bacterial infection. Perioperative antibiotic prophylaxis is an important preventive measure and local tissue concentrations can be quantified with microdialysis. Insertion of spinal implants induces tissue trauma and inflammation, which may affect antibiotic proximate implant concentrations. We compared perioperative cefuroxime concentrations inside a cannulated pedicle screw used in minimally invasive spine surgery with the opposite non-instrumented vertebral pedicle.Materials and methods: Microdialysis catheters were placed inside a cannulated pedicle screw and in the opposite non-instrumented vertebral pedicle of the same vertebra (L1) in 8 female pigs through a posterior lumbar surgical approach. Following a single-dose intravenous cefuroxime administration (1.5 g), dialysates and plasma were dynamically sampled over 8 hours. The primary endpoint was time above the cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 μg/mL (T>MIC4).Results: Median T>MIC4 was 0 h (range 0–0) inside the cannulated pedicle screw, 1.6 h (range 1.1–2.4) in non-instrumented vertebral pedicle, and 1.9 h (range 1.9–2.9) in plasma.Conclusion: A single-dose intravenous cefuroxime administration provided low and subtherapeutic concentrations for prevention of infection inside a cannulated pedicle screw in the lumbar spine. Therapeutic concentrations were achieved in the opposite non-instrumented vertebral pedicle up to 1.5–2 h. Therefore, additional prophylactic strategies may be considered in cannulated instrumented spine surgery, especially in high-risk patients. Alternative dosing regimens seem relevant in lumbar spine surgery lasting longer than 1.5 h.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study

Hvistendahl

Hanberg

Stilling

et al. 2022

ActaO

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show abstract

“…The study was reported in compliance with the ARRIVE guidelines (Percie du Sert et al, 2020) and with the recommendations made by the British Journal of Pharmacology (Lilley et al, 2020). With reference to reduction, refinement and replacement (the 3Rs) (Tannenbaum & Bennett, 2015), the pigs used in this study were also included in studies assessing cefuroxime concentrations in the anterior and posterior vertebral column of the spine and inside a cannulated pedicle screw (Hvistendahl, Bue, et al, 2022; Hvistendahl, Hanberg, et al, 2022).…”

Section: Methodsmentioning

confidence: 99%

“…The intermediate precision for the internal controls at four levels, determined over 43 runs, for cefuroxime was 14.2% (target 0.010 μg·ml −1 ), 9.6% (target 0.050 μg·ml −1 ), 2.6% (target 5.00 μg·ml −1 ), and 3.9% (target 10.00 μg·ml −1 ), whereas it was 16.6% (target 0.050 μg·ml −1 ), 3.9% (target 5.00 μg ml −1 ), and 5.6% (target 10.00 μg·ml −1 ) for meropenem at three levels, determined over 36 runs. The chemical analysis has previously been applied in studies examining cefuroxime concentrations (Hvistendahl, Bue, et al, 2022; Tøstesen et al, 2022).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of cefuroxime concentration in the intrathecal and extrathecal compartments of the lumbar spine—an experimental study in pigs

Kaspersen

Hanberg

Hvistendahl

et al. 2023

British J Pharmacology

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Background and Purpose Optimal antibiotic prophylaxis is crucial to prevent postoperative infection in spinal surgery. Sufficient time above the minimal inhibitory concentration (fT > MIC) for relevant bacteria in target tissues is required for cefuroxime. We assessed cefuroxime concentrations and fT > MIC of 4 μg·ml−1 for Staphylococcus aureus in the intrathecal (spinal cord and cerebrospinal fluid, CSF) and extrathecal (epidural space) compartments of the lumbar spine. Experimental Approach Eight female pigs were anaesthetized and laminectomized at L3–L4. Microdialysis catheters were placed for sampling in the spinal cord, CSF, and epidural space. A single dose of 1500 mg cefuroxime was administered intravenously over 10 min. Microdialysates and plasma were obtained continuously during 8 h. Cefuroxime concentrations were determined by ultra‐high‐performance liquid chromatography. Key Results Mean fT > MIC (4 μg·ml−1) was 58 min in the spinal cord, 0 min in the CSF, 115 min in the epidural space, and 123 min in plasma. Tissue penetration was 32% in the spinal cord, 7% in the CSF, and 63% in the epidural space. Conclusion and Implications fT > MIC (4 μg·ml−1) and tissue penetration for cefuroxime were lower in the intrathecal compartments (spinal cord and CSF) than in the extrathecal compartment (epidural space) and plasma, suggesting a significant effect of the blood–brain barrier. In terms of fT > MIC, a single dose of 1500 mg cefuroxime seems inadequate to prevent intrathecal infections related to spinal surgery for bacteria presenting with a MIC target of 4 μg· ml−1 or above.

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Plasma concentration of prophylactic cefazolin best correlates with lean body mass measured by bioimpedance analysis in lumbar spine surgery: Results of a pilot study

Pett,

Petry,

Martyn

et al. 2023

Journal of Clinical Neuroscience

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Cefuroxime concentrations in the anterior and posterior column of the lumbar spine – an experimental porcine study

Cited by 3 publications

References 32 publications

Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study

Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study

Evaluation of cefuroxime concentration in the intrathecal and extrathecal compartments of the lumbar spine—an experimental study in pigs

Plasma concentration of prophylactic cefazolin best correlates with lean body mass measured by bioimpedance analysis in lumbar spine surgery: Results of a pilot study

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