Aarhus Denmark Microdialysis Research Group (ADMIRE), Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus.
Aarhus Denmark Microdialysis Research Group (ADMIRE), Orthopaedic Research Unit, Aarhus University Hospital, Aarhus.
Acta Orthop. 2024 Sep 6;95:498-504. doi: 10.2340/17453674.2024.41343.
The duration of antibiotic coverage in hand tissues during surgery is unknown. We investigated the time the free concentration of cefuroxime was above the minimal inhibitory concentration (fT>MIC) of 4 μg/mL in hand tissues after single and repeated administration.
In a prospective, unblinded randomized study 16 patients (13 female, age range 51-80 years) underwent trapeziectomy. Microdialysis catheters were placed in the metacarpal bone (primary effect parameter), synovial sheath, and subcutaneous tissue. Patients were randomized to postoperative administration of either intravenous single administration of cefuroxime (1,500 mg) (Group 1, n = 8) or repeated dosing (2 x 1,500 mg) with a 4 h interval (Group 2, n = 8). Samples were taken over 8 h.
The fT>MIC of 4 μg/mL was found to be significantly longer in the metacarpal bone in Group 2 compared with Group 1 with a mean difference of 199 min (95% confidence interval 158-239). The same trend was evident in the remaining compartments. A concentration of 4 μg/mL was reached in all compartments in both groups within a mean time of 6 min (range 0-27 min). In Group 1, the mean concentrations decreased below 4 μg/mL between 3 h 59 min and 5 h 38 min.
The fT>MIC was longer after repeated administration compared with single administration in all compartments. A single administration of cefuroxime 1,500 mg provided antimicrobial hand tissue coverage for a minimum of 3 h 59 min. Cefuroxime administration in hand surgeries should be done minimum 27 min prior to incision to achieve sufficient coverage in all individuals. Cefuroxime readministration should be considered in hand surgeries lasting longer than 4 h from time of administration.
手术中手部组织中抗生素覆盖的持续时间尚不清楚。我们研究了单次和重复给药后，手部组织中头孢呋辛游离浓度（fT）超过最小抑菌浓度（MIC）4μg/ml 的时间。
在一项前瞻性、非盲随机研究中，16 名患者（13 名女性，年龄 51-80 岁）接受了腕骨切除术。在手骨（主要效应参数）、滑膜鞘和皮下组织中放置微透析导管。患者随机分为术后静脉单次给予头孢呋辛（1500mg）（第 1 组，n=8）或 4 小时间隔重复给药（2x1500mg）（第 2 组，n=8）。在 8 小时内取样。
第 2 组在手骨中的 fT>MIC 为 4μg/ml 明显长于第 1 组，平均差异为 199 分钟（95%置信区间 158-239）。在其余的隔室中也出现了同样的趋势。两组在平均 6 分钟（0-27 分钟）内所有隔室均达到 4μg/ml 的浓度。在第 1 组中，平均浓度在 3 小时 59 分钟至 5 小时 38 分钟之间降至 4μg/ml 以下。
与单次给药相比，重复给药后所有隔室的 fT>MIC 时间更长。单次给予 1500mg 头孢呋辛可提供至少 3 小时 59 分钟的手部组织抗菌覆盖。在手部手术中，应在切口前至少 27 分钟给予头孢呋辛给药，以确保所有个体均有足够的覆盖。对于从给药开始持续超过 4 小时的手部手术，应考虑重复给予头孢呋辛。
