Nungu K S, Olerud C, Rehnberg L, Larsson S, Nordell P, Allvin I, Bengtsson S, Wallinder L, Hedin G
Department of Orthopaedics, University Hospital, Uppsala, Sweden.
Arch Orthop Trauma Surg. 1995;114(6):303-7. doi: 10.1007/BF00448952.
A prospective, randomized study was performed in 559 patients to compare two doses of oral cefadroxil with three doses of intravenous cefuorxime as antibiotic prophylaxis in intra- and subtrochanteric hip fracture surgery. Antibiotic concentrations in the wound fluid were determined at the start and at the end of the operation. The first dose of cefadroxil was given about 2 h before surgery and cefuroxime about 30 min before operation. In 226/242 (93%) patients randomized to oral cefadroxil, the concentration in the wound during surgery was on average 15 micrograms/ml, i.e., well above the minimum inhibitory concentration (MIC-90) for Staphylococcus aureus. In the cefuroxime group, antibiotic levels in the wound exceeded the MIC-90 for S. aureus in 204/210 (97%) of the patients at the start and/or at the end of surgery. All patients were followed up for 4 months. One deep and five superficial infections occurred in the cefuroxime group and no deep but one superficial infection in the cefadroxil group (P = 0.07). S. aureus was cultured in three of the infected cases while cultures were negative in four patients. Four of the seven infected patients had adequate levels of antibiotic in the wound during surgery, and in three patients no antibiotic assay was performed. The infected patients did not differ in age, sex, operation time, bleeding or any other basic variable compared with patients who healed without complications. Two doses of cefadroxil seems to be practical and as effective as intravenously administered cefuroxime as antibiotic prophylaxis in trochanteric hip fracture surgery.
对559例患者进行了一项前瞻性随机研究，比较两剂口服头孢羟氨苄与三剂静脉注射头孢呋辛作为转子间和转子下髋部骨折手术抗生素预防用药的效果。在手术开始时和结束时测定伤口液中的抗生素浓度。头孢羟氨苄的首剂在手术前约2小时给予，头孢呋辛在手术前约30分钟给予。在随机接受口服头孢羟氨苄的226/242例（93%）患者中，手术期间伤口中的浓度平均为15微克/毫升，即远高于金黄色葡萄球菌的最低抑菌浓度（MIC-90）。在头孢呋辛组中，在手术开始时和/或结束时，204/210例（97%）患者伤口中的抗生素水平超过了金黄色葡萄球菌的MIC-90。所有患者均随访4个月。头孢呋辛组发生1例深部感染和5例浅表感染，头孢羟氨苄组无深部感染但有1例浅表感染（P = 0.07）。7例感染病例中有3例培养出金黄色葡萄球菌，4例患者培养结果为阴性。7例感染患者中有4例在手术期间伤口中有足够的抗生素水平，3例患者未进行抗生素检测。与无并发症愈合的患者相比，感染患者在年龄、性别、手术时间、出血量或任何其他基本变量方面无差异。两剂头孢羟氨苄作为转子间髋部骨折手术抗生素预防用药似乎切实可行，且与静脉注射头孢呋辛效果相当。
