Torkington M S, Davison M J, Wheelwright E F, Jenkins P J, Anthony I, Lovering A M, Blyth M, Jones B
Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.
Bone Joint J. 2017 Mar;99-B(3):358-364. doi: 10.1302/0301-620X.99B3.BJJ-2016-0328.R1.
To investigate the bone penetration of intravenous antibiotic prophylaxis with flucloxacillin and gentamicin during hip and knee arthroplasty, and their efficacy against () and .
Bone samples from the femoral head, neck and acetabulum were collected from 18 patients undergoing total hip arthroplasty (THA) and from the femur and tibia in 21 patients during total knee arthroplasty (TKA). The concentration of both antibiotics in the samples was analysed using high performance liquid chromatography. Penetration was expressed as a percentage of venous blood concentration. The efficacy against common infecting organisms was measured against both the minimum inhibitory concentration 50, and the more stringent epidemiological cutoff value for resistance (ECOFF).
The bone penetration of gentamicin was higher than flucloxacillin. Relative to ECOFF, flucloxacillin concentrations were effective against and in all THAs and 20 (95%) TKAs. Gentamicin concentrations were effective against in all bone samples. Gentamicin was effective against in 11 (61.1%) femoral neck samples in THA. Effective concentrations of gentamicin against were only achieved in four (19%) femoral and six (29%) tibial samples in TKA.
Flucloxacillin and gentamicin were found to penetrate bone during THA and TKA. Gentamicin was effective against in both THA and TKA, while levels were subtherapeutic against in most TKAs. Bone penetration of both antibiotics was less in TKA than THA, and may relate to the use of a tourniquet. Using this antibiotic combination, effective cover against the two common infective organisms was achieved in all THAs and all but one TKA. Cite this article: 2017;99-B:358-64.
研究氟氯西林和庆大霉素在髋膝关节置换术中静脉应用抗生素预防时的骨渗透情况，以及它们对（）和（）的疗效。
从18例行全髋关节置换术（THA）患者的股骨头、颈和髋臼以及21例行全膝关节置换术（TKA）患者的股骨和胫骨采集骨样本。采用高效液相色谱法分析样本中两种抗生素的浓度。渗透情况以静脉血浓度的百分比表示。针对常见感染病原体的疗效通过最低抑菌浓度50以及更严格的耐药流行病学临界值（ECOFF）来衡量。
庆大霉素的骨渗透高于氟氯西林。相对于ECOFF，氟氯西林浓度在所有THA以及20例（95%）TKA中对（）和（）有效。庆大霉素浓度在所有骨样本中对（）有效。在THA中，庆大霉素在11例（61.1%）股骨颈样本中对（）有效。在TKA中，仅在4例（19%）股骨和6例（29%）胫骨样本中达到了庆大霉素针对（）的有效浓度。
发现在THA和TKA过程中氟氯西林和庆大霉素可渗透入骨。庆大霉素在THA和TKA中对（）均有效，而在大多数TKA中针对（）的水平低于治疗浓度。两种抗生素在TKA中的骨渗透低于THA，可能与使用止血带有关。使用这种抗生素组合，在所有THA以及除1例之外的所有TKA中均实现了对两种常见感染病原体的有效覆盖。引用本文：2017；99 - B：358 - 64。
