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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified.

Questions/purposes

We asked whether 2 g of cefazolin would enable effective serum and bone concentrations relative to the current minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus.

Patients and Methods

We enrolled 43 patients (THA, n = 16; TKA, n = 27) scheduled for primary THAs and primary TKAs. Subjects were given 2 g of cefazolin intravenously before incision. One blood sample and two bone samples were collected from each subject before tourniquet deflation before any additional dose. All samples were assayed at the same laboratory. Minimum inhibitory concentration values were defined based on nationwide surveys.

Results

Mean (± standard deviation) serum concentration was 170.3 ± 51.3 μg/mL (range, 99.3–370.3 μg/mL). Mean bone concentration was 32.3 ± 15.2 μg/g (range, 11.4–70.0 μg/g) in THA, and 16.0 ± 10.4 μg/g (range, 6.3–46.3 μg/g) in TKA. All serum and bone concentrations exceeded the minimum inhibitory concentration for methicillin-sensitive S. aureus, but some serum levels were marginal and no bone levels exceeded the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus.

Conclusions

Our data suggest intravenous administration of 2 g of cefazolin achieves the minimum inhibitory concentration for methicillin-sensitive S. aureus in serum and bone, but not the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus in bone, resulting in a potential risk of deep surgical site infections in THAs and TKAs.

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Acknowledgments

We thank Satoshi Kishino for invaluable support for analyzing the samples, Dr. Toshikazu Tsuboi, Dr. Yasuo Ohori, Dr. Toru Iga, Dr. Ichiro Nagai, Dr. Tetsushi Tatsumi, and Dr. Chiemi Touhara for recruiting the patients, and Dr. Ko Matsudaira, Dr. Hiroyuki Oka, and Hiroshi Ohtsu for statistical support during the course of this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Koji Yamada MD & Sakae Tanaka MD, PhD

  2. Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Tokyo, Japan

    Kunihiro Matsumoto PhD

  3. Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

    Fumiaki Tokimura MD

  4. Department of Orthopaedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Hiroshi Okazaki MD, PhD

Authors
  1. Koji Yamada MD
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  2. Kunihiro Matsumoto PhD
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  3. Fumiaki Tokimura MD
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  4. Hiroshi Okazaki MD, PhD
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  5. Sakae Tanaka MD, PhD
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Corresponding author

Correspondence to Koji Yamada MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Tokyo Metropolitan Tama Medical Center (Tokyo, Japan) and Tama-Hokubu Medical Center (Tokyo, Japan).

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Yamada, K., Matsumoto, K., Tokimura, F. et al. Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?. Clin Orthop Relat Res 469, 3486–3494 (2011). https://doi.org/10.1007/s11999-011-2111-8

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  • DOI: https://doi.org/10.1007/s11999-011-2111-8

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