Prophylactic Antibiotics in Orthopaedic Surgery

Prokuski, Laura

doi:10.5435/00124635-200805000-00007

Cited by 260 publications

(227 citation statements)

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“…In a previous study, we observed that CoNS was the predominant pathogen cultured from patients' surgical sites, in the same study period [37]. Currently, 80% of CoNS strains are reportedly methicillin-resistant [25]. According to domestic surveys [13,17,18,38], resistance to cefazolin is seen in many CoNS species, with a MIC 90 of 100 lg/mL or greater in approximately half of the reported species (Table 2).…”

Section: Discussionmentioning

confidence: 74%

“…Just because the range may at its upper border exceed the attainable bone or even serum concentrations does not mean that for a majority of patients, cefazolin prophylaxis would not be adequate. However, concerns remain owing to the increasing antibiotic resistance observed among human pathogens, which is an important issue in directing future recommendations for surgical antibiotic prophylaxis [25]. Institutions using cefazolin as a first-choice agent for antimicrobial prophylaxis for patients having THAs and TKAs, with CoNS as the main pathogen of SSI, should be aware of the possible failure using cefazolin as described in this study.…”

Section: Discussionmentioning

confidence: 99%

“…As similar results have been reported in subsequent studies [7,24], CoNS must be considered an important pathogen for targeting in antimicrobial prophylaxis. Moreover, CoNS has been recognized as the predominant causative organism for prosthetic joint infections [20,21,28], and globally one of the most resistant [14,25]. Moran et al [20] reported that 47% of causative organisms for prosthetic joint infections were CoNS, 60% of which were methicillin-resistant, followed by MSSA.…”

Section: Discussionmentioning

confidence: 99%

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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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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 lg/mL (range, 99.3-370.3 lg/mL). Mean bone concentration was 32.3 ± 15.2 lg/g (range, 11.4-70.0 lg/g) in THA, and 16.0 ± 10.4 lg/g (range, 6.3-46.3 lg/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 coagulasenegative 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.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…One of the most common causes of SSI are the native microorganisms of the skin (47,48). In a study by von Eiff et al it was shown that in more than 80% of nosocomial infections with Staphylococcus aureus, the source of the infection was endogenous based on the genotyping evaluations (49).…”

Section: Preoperative Skin Preparation Patientsmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

119

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“…47,48 In a study by von Eiff et al 49 it was shown that in more than 80% of nosocomial infections with Staphylococcus aureus, the source of the infection was endogenous, based on the genotyping evaluations.…”

Section: Pre-operative Skin Preparation Patientsmentioning

confidence: 99%