Clinical Bacteriology of Cephazolin

McAllister, Tim A.; Tait, Susan C.; Perman, Mary G.; Park, Alison C.

doi:10.1177/003693307502000509

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Because CFZ is bactericidal, obtains high levels within the synovial fluid within 30 to 60 min, and has a broad spectrum of coverage, it is recommended for preoperative prophylaxis in procedures that breach the joint capsule (33). Based on our data, postprophylactic synovial fluid concentrations are ϳ100 to 200 g/ml, which is ϳ400ϫ the MIC for S. aureus (9). These concentrations were determined through the testing of 23 synovial fluid samples containing preoperative CFZ.…”

Section: Discussionmentioning

confidence: 99%

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Staphylococcal Persistence Due to Biofilm Formation in Synovial Fluid Containing Prophylactic Cefazolin

Dastgheyb

Hammoud

Ketonis

et al. 2015

Antimicrob Agents Chemother

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Antibiotic prophylaxis is standard for patients undergoing surgical procedures, yet despite the wide use of antibiotics, breakthrough infections still occur. In the setting of total joint arthroplasty, such infections can be devastating. Recent findings have shown that synovial fluid causes marked staphylococcal aggregation, which can confer antibiotic insensitivity. We therefore asked in this study whether clinical samples of synovial fluid that contain preoperative prophylactic antibiotics can successfully eradicate a bacterial challenge by pertinent bacterial species. This study demonstrates that preoperative prophylaxis with cefazolin results in high antibiotic levels. Furthermore, we show that even with antibiotic concentrations that far exceed the expected bactericidal levels, Staphylococcus aureus bacteria added to the synovial fluid samples are not eradicated and are able to colonize model implant surfaces, i.e., titanium pins. Based on these studies, we suggest that current prophylactic antibiotic choices, despite high penetration into the synovial fluid, may need to be reexamined.I nfection remains a major concern with orthopedic procedures, although infection rates are generally Ͻ1% (1). Because of the high prophylactic antibiotic levels within synovial fluid, the use of minimally invasive techniques, and short surgical times, infection rates remain low. However, with increasing numbers of total knee arthroplasties, infections are projected to exceed 60,000 to 70,000 cases in the United States by 2020 (2, 3). When hardware, such as a prosthesis, is present, infection is recalcitrant to antibiotic treatment. Once established, infection can cause prolonged disability, multiple operations, and increased health care costs (3, 4). According to the WHO, patients with a surgical site infection have twice the mortality rate, are twice as likely to spend time in an intensive care unit, and are five times more likely to be readmitted to the hospital than uninfected patients (5).To avoid the establishment of infection, antibiotic prophylaxis has become the standard of care (6, 7). For orthopedic procedures, cefazolin (CFZ), which is bactericidal for staphylococci, streptococci, and Escherichia coli (8, 9), is commonly used in the absence of a penicillin allergy (10). Alternative prophylactic antibiotics include fusidic acid, cloxacillin (11), cefixime (12), vancomycin, and gentamicin (13). Interestingly, synovial fluid has been suggested to possess antibacterial properties (14-16) that are attributed to hyaluronic acid within the synovial fluid (17), the induction of bactericidal/permeability-increasing protein (15), or unknown compounds, including antimicrobial peptides, within the synovial fluid (14). We recently reported that this ostensible decrease in bacterial numbers, which is perceived to be an "antibacterial" effect, is actually due to the clumping of bacteria within synovial fluid, which masks the true microbial load levels (18).The recognition of this behavior also helps to elucidate the difficulties ...

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Section: Discussionmentioning

confidence: 99%

“…For orthopedic procedures, cefazolin (CFZ), which is bactericidal for staphylococci, streptococci, and Escherichia coli (8,9), is commonly used in the absence of a penicillin allergy (10). Alternative prophylactic antibiotics include fusidic acid, cloxacillin (11), cefixime (12), vancomycin, and gentamicin (13).…”

mentioning

confidence: 99%

Staphylococcal Persistence Due to Biofilm Formation in Synovial Fluid Containing Prophylactic Cefazolin

Dastgheyb

Hammoud

Ketonis

et al. 2015

Antimicrob Agents Chemother

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“…Cephalosporins are weak acids with a low pKa, poor lipid solubility and variable protein binding. They have a broad antibacterial spectrum, are resistant to β-lactamase, rival aminoglycosides as 'best guess' primary choice (McAllister et al, 1976) and exhibit less allergic cross-reactivity with penicillin (Sciacchitano et al, 1994). Cephazolin is water soluble, distributed through most body fl uids and tissues (including joints, bone and soft tissues) and continues to be a reasonable choice for prophylaxis.…”

Section: Amount Of Diluent (µL) X Cephazolin Concentration Measured (mentioning

confidence: 99%

Therapeutic use of cephazolin to prevent complications of spine surgery

et al. 2006

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Discitis, caused by pyogenic organisms, is a potential complication of any procedure which involves entering the intervertebral disc during open or percutaneous procedures. While there are wide variations in the severity of symptoms, the characteristic feature of discitis is the development of increasingly severe back pain, which is not relieved by rest, or narcotic analgesics. While there is a tendency to spontaneous resolution over time, a self-limiting course does not always eventuate. Serious complications resulting from spread of the infective process can lead to vertebral osteomyelitis or to the formation of an epidural abscess with further risk of neural compression. Clinical and experimental evidence now supports the prophylactic use of a suitable antibiotic, but some uncertainties exist about the benefits of antibiotic therapy in treating established discitis. While cephazolin is a widely favoured choice of antibiotic, the timing of its administration to prevent or treat discitis has been complicated by the lack of suitable methods for detecting and measuring the concentration of cephazolin in the plasma and disc in experimental and clinical conditions. This paper describes a high-performance liquid chromatography technique for detecting the antibiotic cephazolin. The results conclude cephazolin can be detected in the plasma and disc after administering an intravenous bolus dose. However, concentration of cephazolin in the outer disc was 12 times greater than that of the inner disc.

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“…It rivals the aminoglycoside group of antibiotics as "best guess" primary choice, 6 is resistant to ␤-lactamase, and shows less allergic crossreactivity with penicillin. 7 However, because of its overall negative charge, 8,9 it is questionable whether cephazolin penetrates the disc and, indeed, if it reaches therapeutic levels in all regions.…”

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confidence: 99%

Prophylactic Cephazolin to Prevent Discitis in an Ovine Model

Walters¹,

Rahmat²,

Shimamura³

et al. 2006

Spine

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A single prophylactic 2-g dose of cephazolin administered anytime over a 4-hour period prevented discitis in almost all animals but was not as effective in lambs. Although lambs have a higher vascular supply to deliver antibiotics to the disc, it is likely that some other physiologic factor may be responsible for the increased infection rate. This study supports that timing of antibiotic prophylaxis is critical to prevent iatrogenic disc infection.

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Clinical Bacteriology of Cephazolin

Cited by 5 publications

References 19 publications

Staphylococcal Persistence Due to Biofilm Formation in Synovial Fluid Containing Prophylactic Cefazolin

Staphylococcal Persistence Due to Biofilm Formation in Synovial Fluid Containing Prophylactic Cefazolin

Therapeutic use of cephazolin to prevent complications of spine surgery

Prophylactic Cephazolin to Prevent Discitis in an Ovine Model

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