■皮肤切口前预防性使用抗生素是预防关节成形术手术中假体周围感染的重要组成部分。为了有效的抗生素,局部组织浓度(LTC)必须超过典型感染生物的最低抑制浓度;然而,关节成形术期间头孢唑林的LTC了解甚少。
■为了比较血清中头孢唑林的全身浓度与脂肪中的LTC,滑膜,在初次全膝关节置换术(TKA)期间评估止血带膨胀的效果。
■这项前瞻性随机临床试验于2022年3月1日至2023年6月30日在一个学术中心接受TKA的患者中进行。
■使用或不使用止血带的全膝关节置换术。
■手术部位的全身血液和局部组织(脂肪,滑膜,和骨)在手术期间定期收获。主要结果是头孢唑林的LTC,使用液相色谱-串联质谱技术定量。
■共有59名患者被纳入研究,止血带组29岁(平均[SD]年龄,69.3[9.6]岁;女性23[79.3%])和无止血带组30(平均[SD]年龄,69.9[9.7]岁;21[70.0%]女性)。在没有止血带的TKA患者中,血清中头孢唑林的平均浓度为71.9μg/mL(95%CI,66.4-77.5μg/mL),而脂肪中的平均LTC为13.9μg/g(95%CI,12.1-15.7μg/g),滑膜中27.7μg/g(95%CI,24.3-31.0μg/g),和17.7μg/g(95%CI,14.8-20.5μg/g)。对于使用止血带进行TKA的患者,血清中头孢唑林的平均浓度为72.0μg/mL(95%CI,66.3-77.7μg/mL),脂肪中的平均LTC为9.9μg/g(95%CI,8.7-11.1μg/g),滑膜中21.8μg/g(95%CI,18.7-25.0μg/g),骨中13.0μg/g(95%CI,10.8-15.2μg/g)。使用止血带导致头孢唑林输注后60分钟的平均LTC显着降低(10.8μg/g[95%CI,9.1-12.4μg/g]vs16.9μg/g[95%CI,14.1-19.6μg/g],脂肪P=.001;18.9μg/g[95%CI,14.1-23.6μg/g]vs25.8μg/g[95%CI,21.4-30.3μg/g],滑膜P=0.03;和11.8μg/g[95%CI,9.3-14.2μg/g]vs19.4μg/g[95%CI,14.5-24.4μg/g],P=.007in骨)。
■在这项随机临床试验中,局部组织中头孢唑林的浓度较低(脂肪,滑膜,和骨骼)比全身血液中,并且使用肢体止血带进一步显着降低了这些浓度。尽管目前头孢唑啉的预防性给药方案提供了足够的血清浓度,TKA期间关节周围组织的水平可能不足以预防假体周围关节感染。
■ClinicalTrials.gov标识符:NCT05604157。
UNASSIGNED: Prophylactic administration of antibiotics before skin incision is an important component in the prevention of periprosthetic joint infection in arthroplasty surgery. For antibiotics to be effective, the local tissue concentration (LTC) must exceed the minimum inhibitory concentration of typical infecting organisms; however, the LTC of cefazolin during arthroplasty is poorly understood.
UNASSIGNED: To compare the systemic concentration of cefazolin in serum with the LTC in fat, synovium, and bone during primary total knee arthroplasty (TKA) while assessing the effect of tourniquet inflation.
UNASSIGNED: This prospective randomized clinical trial was conducted from March 1, 2022, to June 30, 2023, in patients undergoing TKA at a single academic center.
UNASSIGNED: Total knee arthroplasty with or without a limb tourniquet.
UNASSIGNED: Systemic blood and local tissues from the surgical site (fat, synovium, and bone) were harvested at regular intervals during the surgery. The primary outcome was the LTC of cefazolin, quantified using the liquid chromatography-tandem mass spectrometry technique.
UNASSIGNED: A total of 59 patients were included in the study, with 29 in the tourniquet group (mean [SD] age, 69.3 [9.6] years; 23 [79.3%] female) and 30 in the no tourniquet group (mean [SD] age, 69.9 [9.7] years; 21 [70.0%] female). In patients undergoing TKA without a tourniquet, the mean concentration of cefazolin in serum was 71.9 μg/mL (95% CI, 66.4-77.5 μg/mL), whereas the mean LTCs were 13.9 μg/g (95% CI, 12.1-15.7 μg/g) in fat, 27.7 μg/g (95% CI, 24.3-31.0 μg/g) in synovium, and 17.7 μg/g (95% CI, 14.8-20.5 μg/g) in bone. For patients undergoing TKA with a tourniquet, the mean concentration of cefazolin in serum was 72.0 μg/mL (95% CI, 66.3-77.7 μg/mL), and the mean LTCs were 9.9 μg/g (95% CI, 8.7-11.1 μg/g) in fat, 21.8 μg/g (95% CI, 18.7-25.0 μg/g) in synovium, and 13.0 μg/g (95% CI, 10.8-15.2 μg/g) in bone. The use of a tourniquet resulted in significantly lower mean LTCs by 60 minutes after cefazolin infusion (10.8 μg/g [95% CI, 9.1-12.4 μg/g] vs 16.9 μg/g [95% CI, 14.1-19.6 μg/g], P = .001 in fat; 18.9 μg/g [95% CI, 14.1-23.6 μg/g] vs 25.8 μg/g [95% CI, 21.4-30.3 μg/g], P = .03 in synovium; and 11.8 μg/g [95% CI, 9.3-14.2 μg/g] vs 19.4 μg/g [95% CI, 14.5-24.4 μg/g], P = .007 in bone).
UNASSIGNED: In this randomized clinical trial, the concentration of cefazolin was lower in local tissues (fat, synovium, and bone) than in systemic blood, and the use of a limb tourniquet further significantly reduced these concentrations. Although the current prophylactic dosing regimen for cefazolin provides sufficient serum concentrations, the levels in the periarticular tissue during TKA may be insufficient to prevent periprosthetic joint infection.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT05604157.