Related Experiment Video

Updated: Aug 5, 2026

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials
06:18

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

Published on: March 3, 2023

Antimicrobial prophylaxis regimens in joint replacement surgery: Susceptibility and PK/PD target attainment

Alba Rivera1, Sonia Luque2, Isabel Mur3

  • 1Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.

International Journal of Antimicrobial Agents
|July 29, 2026
PubMed
Abstract

Insights

Cefazolin may still be effective against methicillin-resistant coagulase-negative staphylococci (CoNS) in surgical prophylaxis, despite non-susceptibility. Vancomycin-based regimens showed high performance, but cefazolin-based options were comparable for preventing joint infections.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacokinetics/Pharmacodynamics

Background:

  • Surgical antimicrobial prophylaxis is crucial for preventing prosthetic joint infections (PJIs).
  • Optimizing antibiotic choice requires balancing pathogen activity and drug concentrations throughout surgery.
  • This study evaluates common prophylactic regimens for primary total knee or hip arthroplasty.

Purpose of the Study:

  • To compare the microbiological coverage and pharmacokinetic/pharmacodynamic (PK/PD) target attainment of cefazolin, cefuroxime, and vancomycin, with or without gentamicin.
  • To assess the effectiveness of these antibiotic regimens in preventing PJIs.

Main Methods:

  • Linked datasets of PJI isolates and patient plasma antibiotic concentrations.
  • Determined antibiotic susceptibility and minimum inhibitory concentrations (MICs) for PJI pathogens.
  • Assessed microbiological coverage and PK/PD target attainment based on isolate-specific MICs and drug concentrations.

Main Results:

  • Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the predominant pathogens.
  • Vancomycin demonstrated the highest single-agent coverage and PK/PD attainment.
  • Cefazolin showed a discrepancy, with potential activity against methicillin-resistant CoNS despite categorical non-susceptibility.
  • Gentamicin significantly improved coverage and PK/PD attainment, particularly against Gram-negative bacteria.

Conclusions:

  • Cefazolin may offer prophylactic benefits against methicillin-resistant CoNS beyond standard susceptibility testing.
  • Vancomycin-containing regimens exhibited high PK/PD performance but were not significantly superior to cefazolin-based regimens.
  • Gentamicin addition enhances Gram-negative pathogen activity in surgical prophylaxis.
Keywords:
ArthroplastyPK/PDProsthetic joint infectionSurgical antimicrobial prophylaxisSurgical site infection

More Related Videos

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction10:35

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Published on: December 3, 2017

Related Concept Videos

Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Clinical Significance of Antibiotic Resistance01:25

Clinical Significance of Antibiotic Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within the One...
Antimicrobial Effectiveness01:28

Antimicrobial Effectiveness

The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
Mechanism of Antibiotic Resistance in MRSA01:25

Mechanism of Antibiotic Resistance in MRSA

Antibiotic resistance in bacteria arises when microorganisms evolve the ability to withstand drugs designed to kill them or inhibit their growth, rendering once-effective treatments useless. This phenomenon, driven by genetic change and selection under antibiotic exposure, poses a profound threat to modern medicine. Mechanisms include drug-inactivating enzymes (e.g., β-lactamases), efflux pumps that eject antibiotics, mutations altering antibiotic targets, decreased drug uptake, and acquisition...
Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions01:15

Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions

PK–PD modeling has significantly influenced FDA regulatory decisions, particularly drug approval, dosage optimization, and labeling. These models integrate pharmacokinetics (PK) and pharmacodynamics (PD) to predict drug behavior and effects, aiding in optimizing dosing regimens and enhancing the probability of clinical trial success.One notable example is Nesiritide (Natrecor®), a recombinant human brain natriuretic peptide for treating acute decompensated congestive heart failure (CHF).
Endocarditis III: Medical Management01:18

Endocarditis III: Medical Management

Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...