Low prevalence of tissue detection of cefepime and daptomycin used as empirical treatment during revision for periprosthetic joint infections: results of a prospective multicenter study.
Aged
Anti-Bacterial Agents
/ administration & dosage
Cefepime
/ administration & dosage
Daptomycin
/ administration & dosage
Drug Therapy, Combination
Female
Humans
Knee Prosthesis
/ microbiology
Male
Middle Aged
Prospective Studies
Prosthesis-Related Infections
/ drug therapy
Staphylococcus
/ drug effects
Cefepime
Daptomycin
Dosage
Empirical antibiotic therapy
Inhibitory quotient
Periprosthetic joint infection
Tourniquet
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
ISSN: 1435-4373
Titre abrégé: Eur J Clin Microbiol Infect Dis
Pays: Germany
ID NLM: 8804297
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
17
03
2021
accepted:
10
05
2021
pubmed:
21
5
2021
medline:
17
12
2021
entrez:
20
5
2021
Statut:
ppublish
Résumé
Data demonstrating that antibiotics administered intraoperatively in patients with surgical revision for periprosthetic joint infection achieve concentrations exceeding minimal inhibitory concentrations of the identified bacteria at the surgical site when the new implant is inserted are lacking. We prospectively included patients with periprosthetic joint infection operated with one- or two-stage replacement during which cefepime (2g)-daptomycin (10mg/kg) combination was administered intravenously as intraoperative empirical antibiotic treatment. Three biopsies (two bones and one synovial membrane) were taken from each patient just before the insertion of the new implant. Eighteen adults of median age 68 years were included. Knee was involved in 10 patients (55.6%) and surgery consisted in one-/two-stage replacement in 11/7 patients. A tourniquet was used during the intervention in the 10 patients with knee prosthesis. Among 54 tissue samples, cefepime and daptomycin were detected respectively in 35 (64.8%) and 21 (38.9%) cases (P=0.01). A total of 17 bacteria dominated by staphylococci (n=14) were identified in 10 patients; tissue inhibitory quotient calculated in 51 samples was >1 in 22 cases (43.1%) for cefepime and in 16 cases (31.4%) for daptomycin. The proportion of tissue samples with detectable antibiotic was significantly higher in hip versus knee prosthesis (P=0.03). The present study suggests that intraoperative empirical administration of cefepime-daptomycin combination during septic prosthetic joint replacement results in a high proportion of tissue samples in which at least one of the two antibiotics was not detected or at a low concentration despite satisfactory concomitant blood serum concentrations.
Identifiants
pubmed: 34014434
doi: 10.1007/s10096-021-04277-4
pii: 10.1007/s10096-021-04277-4
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cefepime
807PW4VQE3
Daptomycin
NWQ5N31VKK
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2285-2294Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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