ca32607c292cde5c59ac277bd67630ee antibiotics_a2021v10n1p18.pdf 4c49b4f145d592e0c596655ec3c339b4066fe2f5 antibiotics_a2021v10n1p18.pdf 19b91a177c38d5e5feee32b95c8857d40fe57aa993782a76f990b39675e59ac8 antibiotics_a2021v10n1p18.pdf Title: Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement Subject: Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined. Keywords: surgical antimicrobial prophylaxis; knee arthroplasty; hip arthroplasty; prosthetic joint infection; surgical site infection prevention; prosthetic joint infection prevention; intraoperative cultures; antibiotic levels; serum bactericidal titer Author: Alba Rivera, Alba Sánchez, Sonia Luque, Isabel Mur, Lluís Puig, Xavier Crusi, José Carlos González, Luisa Sorlí, Aránzazu González, Juan Pablo Horcajada, Ferran Navarro and Natividad Benito Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Dec 29 14:25:10 2020 CET ModDate: Tue Dec 29 14:31:57 2020 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 638733 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HKBJPQ+VnURWPalladioL Type 1 Custom yes yes no 10 0 LIOIFV+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 LLXVOV+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 JHGWPF+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 IOJCNK+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 37 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 59 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 63 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 67 0 UWJUYN+CMSY10 Type 1 Builtin yes yes no 82 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 86 0 TAIOBQ+URWPalladioL-BoldItal Type 1 Custom yes yes no 96 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 114 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 118 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 122 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 126 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 133 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 140 0 Arial-BoldMT TrueType WinAnsi no no no 144 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:57:16 CEST RepresentationInformation: antibiotics_a2021v10n1p18.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 11:50:14 CEST Size: 638733 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 324 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Patients and Methods Destination: section.2 Children: Item: Title: Setting and Patients Destination: subsection.2.1 Item: Title: Surgical Antimicrobial Prophylaxis Regimens Destination: subsection.2.2 Item: Title: Sample Collection Destination: subsection.2.3 Item: Title: Determination of Antibiotic Levels Destination: subsection.2.4 Item: Title: Microbiological Methods Destination: subsection.2.5 Item: Title: Statistical Methods Destination: subsection.2.6 Item: Title: Results Destination: section.3 Children: Item: Title: Patients and Surgical Antimicrobial Prophylaxis Destination: subsection.3.1 Item: Title: Intraoperative Cultures Destination: subsection.3.2 Item: Title: Susceptibility of Bacterial Isolates and ATCC Strains, Antibiotic Plasma Levels and Serum Bactericidal Titers Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: References Destination: section.4 Info: Title: Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement Author: Alba Rivera, Alba Sánchez, Sonia Luque, Isabel Mur, Lluís Puig, Xavier Crusi, José Carlos González, Luisa Sorlí, Aránzazu González, Juan Pablo Horcajada, Ferran Navarro and Natividad Benito Subject: Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229 0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8 1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined. 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