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
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.
Antibiotics (Basel). 2020 Dec 27;10(1):18. doi: 10.3390/antibiotics10010018.
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 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.
外科抗菌预防（SAP）对于预防人工关节感染（PJI）很重要，且必须对最有可能污染手术部位的微生物有效。我们的目的是比较全膝关节置换术（TKA）和全髋关节置换术（THA）患者中不同的SAP方案（头孢唑林、头孢呋辛或万古霉素，单独使用或与庆大霉素联合使用）。在这项临床前探索性分析中，我们分析了术中样本培养结果、血浆抗生素水平与手术伤口分离细菌及美国典型培养物保藏中心（ATCC）菌株的最低抑菌浓度（MIC）之比，以及针对相同微生物的血清杀菌效价（SBT）。纳入了128例患者的132例外科手术（68例TKA，64例THA）。57例（43.2%）手术的培养结果呈阳性（主要为凝固酶阴性葡萄球菌和 菌属）；接受联合SAP的患者组该发生率较低（校正比值比0.475，95%置信区间0.229 - 0.987）。所评估的SAP方案在几乎所有术中分离株中均达到高于MIC的血浆水平（93/94，98.9%），并对所有分离株显示出杀菌活性（SBT范围为1:8 - 1:1024），尽管接受含头孢唑林和庆大霉素方案的患者SBT更高。这些发现对于预防PJI的潜在临床相关性仍有待确定。
