Regional Prophylaxis with Teicoplanin in Monolateral or Bilateral Total Knee Replacement: an Open Study

Abstract

, patients undergoing primary elective monolateral or bilateral total knee replacement (TKR) were consecutively enrolled in a prospective, open clinical study on the efficacy and safety of regional prophylaxis with teicoplanin (TEC). Those scheduled for monolateral TKR (115 patients) received 400 mg of TEC in 100 ml of saline as a 5-min infusion into a foot vein of the leg to be operated on immediately after the tourniquet was inflated to 400 mm Hg (ca. 50 kPa). For patients undergoing bilateral surgery (45 patients), regional administration of TEC was also repeated for the second knee operation. Follow-up ranged from a minimum of 2 years to 8 years. None of the patients experienced local or systemic adverse effects following regional administration of TEC. In the immediate postoperative and 2-year follow-up periods, only one superficial infection of the primary site attributable to intraoperative contamination (prophylaxis failure) out of the 205 prostheses implanted was observed. Deep infections involving the prosthesis did not occur. Infectious complications at distant sites were observed in nine cases (urinary tract infection due to Escherichia coli in eight cases, and Salmonella enteritidis gastroenteritis in one case) in the immediate postoperative period; they all were rapidly cured after antibiotic treatment. A delayed prosthetic infection, related to hematogenous spread of the etiological agent and therefore not considered a prophylactic failure, was observed in a patient who had undergone TKR 5 years before. Regional administration of TEC in monolateral and bilateral TKR appears to be a safe and valuable prophylactic technique.

Higher Cefazolin Concentrations with Intraosseous Regional Prophylaxis in TKA

“…Tissue samples (skin, subcutaneous tissue, bone, synovium) 2-10 times higher through regional route de Lalla et al [9] Clinical study 160 patients (205 knees) undergoing TKA, 400 mg teicoplanin through the foot vein…”

“…Some authors have used a foot vein cannula for administering prophylactic antibiotics in TKA. With this approach, substantially higher tissue concentrations of antibiotic can be achieved at the surgical site without systemic side effects [8,9,15,17] (Table 1). However, cannulation of a foot vein is difficult, time-consuming, and may compromise sterility.…”

Determination of Vancomycin in Human Plasma, Bone and Fat by Liquid Chromatography/Tandem Mass Spectrometry

“…Regional administration utilising a tourniquet has been suggested [7], and performing this via the intraosseous route is currently under investigation. The advantages of regional administration include reducing systemic drug concentrations and side effects while achieving higher tissue concentrations at the operative site.…”

Hemoperfusion with Polymyxin B-Immobilized Fiber in Septic Patients with Methicillin-Resistant <i>Staphylococcus aureus</i>-Associated Glomerulonephritis

“…Yamashita et al [4]suggested that complete eradication of MRSA is necessary to treat MRSA-associated glomerulonephritis, and if this is not attained, permanent loss of renal function may occur. Many investigators have examined the clinical efficacy of teicoplanin given daily for treatment of MRSA infection [5, 6]. Extracorporeal blood purification therapies represent a promising new approach to the adjuvant treatment of sepsis and systemic inflammation [7].…”