Summary
Cefuroxime was given during operation to 95 patients undergoing 106 total joint replacements (hip 69: knee 37). Two regimes were used. Either 1 g was given intravenously with induction of anaesthesia and then two intramuscular injections of 1 g 6 and 12 h later, or 1.5 g was given intravenously with induction and two injections of 750 mg each intramuscularly 6 and 12 h later.
The concentrations of cefuroxime in bone, capsule and blood were measured in 77 patients. The assays were carried out independently in two laboratories. In most instances concentrations in the bone were above the MICs for likely pathogens, even after allowing for any contaminating blood. Concentrations in synovial capsule were generally higher than in bone.
After a follow-up period of 2 years, two patients developed deep infections. The overall infection rates are comparable with the best results reported in the literature using other propyhlactic antibiotics or with ultra-clean air systems.
Résumé
Le Céfuroxime a été administré en peropératoire à 95 sujets qui ont bénéficié de 106 arthroplasties totales (69 hanches et 37 genoux). Deux protocoles ont été utilisés. Dans l'un on a pratiqué une injection intraveineuse d'1 gr au moment de l'induction anesthésique puis 2 injections intra-musculaires d'1 gr 6 h et 12 h plus tard. Dans le second, l'injection IV au moment de l'induction a été de 1,50 gr et les 2 injections IM de 750 mg.
Les concentrations de céfuroxime dans l'os, la capsule et le sang ont été mesurées chez 77 opérés. Les dosages ont été effectués indépendamment dans deux laboratoires. La plupart du temps les concentrations osseuses ont été supérieures à la CMI des germes pathogènes éventuels même en tenant compte de la présence de sang à ce niveau. Les concentrations dans la capsule et la synoviale ont été généralement plus élevées que dans l'os.
Avec un recul de 2 ans, 2 malades ont présenté une infection profonde. Le pourcentage global d'infection est comparable aux meilleurs résultats publiés concernant l'utilisation d'une antibiothérapie préventive ou de salles hyperstériles.
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Hughes, S.P.F., Want, S., Darrell, J.H. et al. Prophylactic Cefuroxime in Total Joint Replacement. International Orthopaedics 6, 155–161 (1982). https://doi.org/10.1007/BF00267725
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DOI: https://doi.org/10.1007/BF00267725