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Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement

Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or...

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Autores principales: Rivera, Alba, Sánchez, Alba, Luque, Sonia, Mur, Isabel, Puig, Lluís, Crusi, Xavier, González, José Carlos, Sorlí, Luisa, González, Aránzazu, Horcajada, Juan Pablo, Navarro, Ferran, Benito, Natividad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823842/
https://www.ncbi.nlm.nih.gov/pubmed/33375415
http://dx.doi.org/10.3390/antibiotics10010018
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author Rivera, Alba
Sánchez, Alba
Luque, Sonia
Mur, Isabel
Puig, Lluís
Crusi, Xavier
González, José Carlos
Sorlí, Luisa
González, Aránzazu
Horcajada, Juan Pablo
Navarro, Ferran
Benito, Natividad
author_facet Rivera, Alba
Sánchez, Alba
Luque, Sonia
Mur, Isabel
Puig, Lluís
Crusi, Xavier
González, José Carlos
Sorlí, Luisa
González, Aránzazu
Horcajada, Juan Pablo
Navarro, Ferran
Benito, Natividad
author_sort Rivera, Alba
collection PubMed
description Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined.
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spelling pubmed-78238422021-01-24 Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement Rivera, Alba Sánchez, Alba Luque, Sonia Mur, Isabel Puig, Lluís Crusi, Xavier González, José Carlos Sorlí, Luisa González, Aránzazu Horcajada, Juan Pablo Navarro, Ferran Benito, Natividad Antibiotics (Basel) Article Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined. MDPI 2020-12-27 /pmc/articles/PMC7823842/ /pubmed/33375415 http://dx.doi.org/10.3390/antibiotics10010018 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rivera, Alba
Sánchez, Alba
Luque, Sonia
Mur, Isabel
Puig, Lluís
Crusi, Xavier
González, José Carlos
Sorlí, Luisa
González, Aránzazu
Horcajada, Juan Pablo
Navarro, Ferran
Benito, Natividad
Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title_full Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title_fullStr Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title_full_unstemmed Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title_short Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
title_sort intraoperative bacterial contamination and activity of different antimicrobial prophylaxis regimens in primary knee and hip replacement
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823842/
https://www.ncbi.nlm.nih.gov/pubmed/33375415
http://dx.doi.org/10.3390/antibiotics10010018
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