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

Autor:	Rivera A; Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.; Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain., Sánchez A; Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.; Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain., Luque S; Department of Pharmacy, Hospital del Mar-Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain., Mur I; Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Infectious Disease Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.; Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain., Puig L; Department of Orthopedic Surgery and Traumatology, Hospital del Mar-Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain., Crusi X; Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain., González JC; Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain., Sorlí L; Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain.; Department of Infectious Diseases, Hospital del Mar-Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain.; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain., González A; Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain., Horcajada JP; Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Department of Infectious Diseases, Hospital del Mar-Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain., Navarro F; Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.; Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain., Benito N; Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Infectious Disease Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.; Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2020 Dec 27; Vol. 10 (1). Date of Electronic Publication: 2020 Dec 27.
DOI:	10.3390/antibiotics10010018
Abstrakt:	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.
Databáze:	MEDLINE
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