Bicanic Goran, Crnogaca Kresimir, Barbaric Katarina, Delimar Domagoj
Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia.
Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 6, 10000 Zagreb, Croatia.
Med Hypotheses. 2014 Jun;82(6):766-8. doi: 10.1016/j.mehy.2014.03.020. Epub 2014 Mar 25.
Periprosthetic infection is regarded as one of the most feared complications following total knee arthroplasty, developing in 0.4-2% of patients. Staphylococcus aureus and Staphylococcus epidermidis are credited for more than half of all infections. Cefazolin is the most commonly used antibiotic drug in arthroplasty antibiotic prophylaxis worldwide. Guidelines and studies recommend that prophylactic antibiotics should be completely infused within 60 min before the surgical incision. Cefazolin achieves highest peak bone concentrations 40 min after parenteral application with serum half-life of 108 min and bone half-life of 42 min. Respecting the given pharmacokinetics of cefazolin and theoretical mathematical model we hypothesise that parenteral application of cefazolin should be in time period not longer than 30 min before incision (tourniquet inflation) and not less than 10 min before tourniquet inflation if given in bolus. This new regime would provide maximal blood concentration of the cefazolin and almost maximal bone concentration of the cefazolin at the beginning of the operation and at the beginning of the tourniquet inflation.
人工关节周围感染被认为是全膝关节置换术后最可怕的并发症之一，在0.4%-2%的患者中发生。金黄色葡萄球菌和表皮葡萄球菌导致的感染占所有感染的一半以上。头孢唑林是全球关节置换术抗生素预防中最常用的抗生素药物。指南和研究建议预防性抗生素应在手术切口前60分钟内完全输注。头孢唑林在肠胃外给药后40分钟达到最高峰值骨浓度，血清半衰期为108分钟，骨半衰期为42分钟。考虑到头孢唑林给定的药代动力学和理论数学模型，我们假设如果采用大剂量给药，头孢唑林的肠胃外给药应在切口（止血带充气）前不超过30分钟且在止血带充气前不少于10分钟的时间段内进行。这种新方案将在手术开始时和止血带充气开始时提供头孢唑林的最大血药浓度和几乎最大的骨药浓度。
