ABSTRACT
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Subject(s)
Humans , Male , Aged , Sepsis/diagnosis , Flavobacterium/isolation & purification , Flavobacteriaceae Infections/diagnosis , Knee Prosthesis/adverse effects , Prosthesis-Related Infections/diagnosis , Sepsis/etiology , Flavobacteriaceae Infections/etiologyABSTRACT
Objetivo. Existe evidencia científica grado iv de la importancia que el antibiótico administrado preoperatoriamente tiene en la prevención de la infección protésica. Hay controversia en si la isquemia aplicada en la cirugía de estos pacientes puede afectar a la concentración mínima inhibitoria del antibiótico en los tejidos periprotésicos. Para estudiar este fenómeno hemos diseñado un estudio basado en la determinación de la concentración de antibiótico en el tejido sinovial. Material y método. Estudio clínico prospectivo observacional de 32 pacientes intervenidos de prótesis total de rodilla. Se administró 2 g de cefonicid como profilaxis y se utilizó el manguito de isquemia en todos los pacientes, cuantificándose la concentración antibiótica mediante la cromatografía líquida de alta resolución en muestras de tejido sinovial del inicio y del final de la intervención. Resultados. La concentración media de antibiótico fue de 23,16 μg/g (IC del 95%, 19,19-27,13) en las muestras del inicio de la intervención y de 15,45 μg/g (IC del 95%, 13,20-17,69) en las muestras del final, mostrándose superiores a la concentración mínima inhibitoria del cefonicid, establecida en 8 μg/g, siendo estos resultados estadísticamente significativos para ambas concentraciones (p < 0,00001). Discusión. La concentración de antibiótico a lo largo de una intervención estándar de prótesis total de rodilla realizada con isquemia preventiva varía a lo largo de la intervención sufriendo un descenso paulatino. Aun así, la concentración determinada al final de la intervención no fue inferior a la concentración mínima inhibitoria del antibiótico estudiado. Como conclusión, la utilización del manguito de isquemia no aumenta el riesgo de infección (AU)
Objective. There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. Material and method. A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2 g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. Results. The mean concentration of antibiotic was 23.16 μg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 μg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 μg/g. These results were statistically significant for both concentrations (P<.00001). Discussion. The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection (AU)
Subject(s)
Aged , Female , Humans , Male , Knee Injuries/surgery , Knee Injuries , Antibiotic Prophylaxis/instrumentation , Antibiotic Prophylaxis/methods , Antibiotic Prophylaxis , Knee Prosthesis/trends , Knee Prosthesis , Cefonicid/therapeutic use , Evidence-Based Practice/methods , Prospective Studies , Arthroplasty, Replacement, Knee/trends , Chromatography, High Pressure Liquid , Confidence IntervalsABSTRACT
OBJECTIVE: There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. MATERIAL AND METHOD: A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. RESULTS: The mean concentration of antibiotic was 23.16 µg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 µg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 µg/g. These results were statistically significant for both concentrations (P<.00001). DISCUSSION: The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection.
