Local cefuroxime tissue concentrations in the hand after single and repeated administration to 16 patients undergoing trapeziectomy: a randomized controlled trial.

IF 2.5 2区 医学 Q1 ORTHOPEDICS Acta Orthopaedica Pub Date : 2024-09-06 DOI:10.2340/17453674.2024.41343
Andrea René Jørgensen, Pelle Hanberg, Mats Bue, Charlotte Hartig-Andreasen, Nis Pedersen Jørgensen, Maiken Stilling
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Abstract

Background and purpose:  The duration of antibiotic coverage in hand tissues during surgery is unknown. We investigated the time the free concentration of cefuroxime was above the minimal inhibitory concentration (fT>MIC) of 4 μg/mL in hand tissues after single and repeated administration.

Methods:  In a prospective, unblinded randomized study 16 patients (13 female, age range 51-80 years) underwent trapeziectomy. Microdialysis catheters were placed in the metacarpal bone (primary effect parameter), synovial sheath, and subcutaneous tissue. Patients were randomized to postoperative administration of either intravenous single administration of cefuroxime (1,500 mg) (Group 1, n = 8) or repeated dosing (2 x 1,500 mg) with a 4 h interval (Group 2, n = 8). Samples were taken over 8 h.

Results: The fT>MIC of 4 μg/mL was found to be significantly longer in the metacarpal bone in Group 2 compared with Group 1 with a mean difference of 199 min (95% confidence interval 158-239). The same trend was evident in the remaining compartments. A concentration of 4 μg/mL was reached in all compartments in both groups within a mean time of 6 min (range 0-27 min). In Group 1, the mean concentrations decreased below 4 μg/mL between 3 h 59 min and 5 h 38 min.

Conclusion:  The fT>MIC was longer after repeated administration compared with single administration in all compartments. A single administration of cefuroxime 1,500 mg provided antimicrobial hand tissue coverage for a minimum of 3 h 59 min. Cefuroxime administration in hand surgeries should be done minimum 27 min prior to incision to achieve sufficient coverage in all individuals. Cefuroxime readministration should be considered in hand surgeries lasting longer than 4 h from time of administration.

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对 16 名接受梯形切除术的患者进行单次和重复给药后手部局部头孢呋辛组织浓度:随机对照试验。
背景和目的:手术过程中抗生素在手部组织中的覆盖时间尚不清楚。我们研究了单次和多次给药后手部组织中头孢呋辛的游离浓度高于 4 μg/mL 的最小抑菌浓度(fT>MIC)的时间: 在一项前瞻性非盲随机研究中,16 名患者(13 名女性,年龄在 51-80 岁之间)接受了梯形切除术。微透析导管被放置在掌骨(主要影响参数)、滑膜鞘和皮下组织中。患者被随机分配到术后静脉注射头孢呋辛(1,500 毫克)(第 1 组,n = 8)或间隔 4 小时重复给药(2 x 1,500 毫克)(第 2 组,n = 8)。采样时间为 8 小时:结果:与第 1 组相比,第 2 组掌骨中 4 μg/mL 的 fT>MIC 时间明显更长,平均差异为 199 分钟(95% 置信区间为 158-239)。同样的趋势也出现在其余部位。两组所有部位的浓度均在 6 分钟内达到 4 μg/mL(0-27 分钟不等)。第 1 组的平均浓度在 3 小时 59 分钟至 5 小时 38 分钟之间降至 4 微克/毫升以下: 结论:与单次给药相比,所有组别重复给药后的 fT>MIC 都更长。单次给药头孢呋辛 1,500 毫克可在至少 3 小时 59 分钟内为手部组织提供抗菌保护。手部手术中的头孢呋辛用药应在切口前至少 27 分钟进行,以达到对所有患者的充分覆盖。如果手部手术持续时间超过 4 小时,则应考虑再次注射头孢呋辛。
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来源期刊
Acta Orthopaedica
Acta Orthopaedica 医学-整形外科
CiteScore
6.40
自引率
8.10%
发文量
105
审稿时长
4-8 weeks
期刊介绍: Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.
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