Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections

Aboltins, Craig; Berdal, Jan Erik; Casas, Francisco; Corona, Pablo S.; Cuellar, Daniel; Ferrari, Matteo Carlo; Hendershot, Edward F.; Huang, Wei; Kuo, Feng-Chih; Malkani, Arthur L.; Reyes, Fernando; Rudelli, Sergio; Safir, Oleg; Seyler, Thorsten M.; Tan, Timothy L.; Townsend, Robert; Tuncay, İbrahim; Turner, David T.; Winkler, Heinz; Wouthuyzen-Bakker, Marjan; Yates, Adolph J.; Zahár, Ákos

doi:10.1016/j.arth.2018.09.012

Cited by 74 publications

(70 citation statements)

References 97 publications

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“…PJI [24]. Recommendations from the ICM and CDC suggest that the ideal start time is within 1 hour so that a bactericidal concentration is reached by the time the surgical incision is made [21,25], whereas the WHO guidelines specify a broader 2-hour window that accounts for the drug half-life [22]. First-generation or secondgeneration cephalosporins (eg, cefazolin, cefuroxime) cover most bacteria responsible for orthopedic infections and are recommended as first-line agents at single weight-adjusted doses [25].…”

mentioning

confidence: 99%

“…Recommendations from the ICM and CDC suggest that the ideal start time is within 1 hour so that a bactericidal concentration is reached by the time the surgical incision is made [21,25], whereas the WHO guidelines specify a broader 2-hour window that accounts for the drug half-life [22]. First-generation or secondgeneration cephalosporins (eg, cefazolin, cefuroxime) cover most bacteria responsible for orthopedic infections and are recommended as first-line agents at single weight-adjusted doses [25]. Current guidelines advocate a minimum of 2 g cefazolin for patients weighing >70 kg to achieve an effective minimum inhibitory concentration, and an increased weight-adjusted dose of 3 g in patients with an actual body weight >120 kg [25].…”

mentioning

confidence: 99%

“…First-generation or secondgeneration cephalosporins (eg, cefazolin, cefuroxime) cover most bacteria responsible for orthopedic infections and are recommended as first-line agents at single weight-adjusted doses [25]. Current guidelines advocate a minimum of 2 g cefazolin for patients weighing >70 kg to achieve an effective minimum inhibitory concentration, and an increased weight-adjusted dose of 3 g in patients with an actual body weight >120 kg [25]. However, in patients with a high risk of methicillin-resistant Staphylococcus aureus colonization, such as those institutionalized in nursing homes or dialysis units, dual antibiotic prophylaxis with the additional vancomycin or teicoplanin may be indicated [25,26].…”

mentioning

confidence: 99%

“…Current guidelines advocate a minimum of 2 g cefazolin for patients weighing >70 kg to achieve an effective minimum inhibitory concentration, and an increased weight-adjusted dose of 3 g in patients with an actual body weight >120 kg [25]. However, in patients with a high risk of methicillin-resistant Staphylococcus aureus colonization, such as those institutionalized in nursing homes or dialysis units, dual antibiotic prophylaxis with the additional vancomycin or teicoplanin may be indicated [25,26]. There is also evidence that continuing antibiotic treatment beyond 24 hours is not essential and could lead to increased bacterial resistance [27].…”

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confidence: 99%

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Intraoperative and Postoperative Infection Prevention

Goswami

Stevenson

Parvızı

2020

The Journal of Arthroplasty

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Intraoperative and Postoperative Infection Prevention

Goswami

Stevenson

Parvızı

2020

The Journal of Arthroplasty

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“…7 In the latest 2018 meeting, there was a continuing robust agreement supporting cephalosporins as the primary antibiotics of choice for prophylaxis. 8 However, recent scientific evidence has emerged both in favor of, and against the combined use of cefazolin and vancomycin (CV). 5,6,[9][10][11] The value of dual antibiotic prophylaxis in the prevention of SSI remains unclear.…”

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Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

et al. 2019

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The risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

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The limitations of mono‐ and combination antibiotic therapies on immature biofilms in a murine model of implant‐associated osteomyelitis

Tomizawa

Nishitani

Ito

et al. 2020

Journal Orthopaedic Research

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Treatment of implant-associated orthopedic infections remains challenging, partly because antimicrobial treatment is ineffective after a mature biofilm covers the implant surface. Currently, the relative efficacy of systemic mono-and combination standard-of-care (SOC) antibiotic therapies over the course of mature biofilm formation is unknown. Thus, we assessed the effects of cefazoline (CEZ), gentamicin (GM), and vancomycin, with or without rifampin (RFP), on Staphylococcus aureus biofilm formation during the establishment of implant-associated osteomyelitis in a murine tibia model. Quantitative scanning electron microscopy of the implants harvested on Days 0, 3, and 7 revealed that all treatments except CEZ monotherapy significantly reduced biofilm formation when antibiotics started at Day 0 (0.46-to 0.25-fold; p < 0.05). When antibiotics commenced 3 days after the infection, only GM monotherapy significantly inhibited biofilm growth (0.63-fold; p < 0.05), while all antibiotics inhibited biofilm formation in combination with RFP (0.56-to 0.44-fold; p < 0.05). However, no treatment was effective when antibiotics commenced on Day 7. To confirm these findings, we assessed bacterial load via colony-forming unit and histology. The results showed that GM monotherapy and all combination therapies reduced the colony-forming unit in the implant (0.41-to 0.23-fold; p < 0.05); all treatments except CEZ monotherapy reduced the colony-forming unit and staphylococcus abscess communities in the tibiae (0.40-to 0.10-fold; p < 0.05). Collectively, these findings demonstrate that systemic SOC antibiotics can inhibit biofilm formation within 3 days but not after 7 days of infection. The efficacy of SOC monotherapies, CEZ particularly, is very limited. Thus, combination treatment with RFP may be necessary to inhibit implant-associated osteomyelitis.

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Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections

Cited by 74 publications

References 97 publications

Intraoperative and Postoperative Infection Prevention

Intraoperative and Postoperative Infection Prevention

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

The limitations of mono‐ and combination antibiotic therapies on immature biofilms in a murine model of implant‐associated osteomyelitis

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