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Teicoplanin in the prevention of infection in total hip replacement
S Nehrer1, F Thalhammer, E Schwameis
1Universitätsklinik für Orthopädie, AKH-Wien, Universitätskliniken, Vienna, Austria. stefan.nehrer@akh-wien.ac.at
Abstract:
Perioperative antibiotic prophylaxis has been shown to be effective in reducing postoperative wound infections. The rising incidence of infections secondary to methicillin-resistant strains of Staphylococcus aureus. S. epidermidis and S. enterococcal prompted us to administer Teicoplanin to infection in elective total joint arthroplasty. In 111 patients Teicoplanin was given in a single intravenous dose of 10 mg/kg prior to surgery. In the postoperative period no deep infection of the prosthetic device was found in a 14-month follow-up. In two patients the following organisms were isolated from superficial infections of the wound: S. epidermidis (methicillin-sensitive), Pseudomonas aeruginosa, and Enterobacter sp. In no patient was revision surgery necessary. The serum concentration of Teicoplanin was within the therapeutic range during surgery, and tissue levels of Teicoplanin in cancellous (6.2 mg/kg, range 3.8-10.9 mg/kg) and cortical (7.1 mg/kg, range 2.6-12.1 mg/kg) bone during surgery in 16 patients exceeded the minimum inhibitory concentration of 90% (MIC90) of methicillin-resistant strains reported for methicillin-resistant strains. In our experience a single dose regimen of Teicoplanin is a safe and effective method of antibiotic prophylaxis in hip joint replacement, particularly when methicillin-resistant bacteria are present.
Insights
A single dose of Teicoplanin effectively prevents deep prosthetic joint infections in hip replacement surgery. This antibiotic prophylaxis is safe and effective, even against resistant bacteria like MRSA.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pharmacology
Background:
- Postoperative wound infections are a risk in joint arthroplasty.
- Rising incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), S. epidermidis, and enterococci.
- Need for effective antibiotic prophylaxis against resistant pathogens.
Purpose of the Study:
- To evaluate the efficacy and safety of a single intravenous dose of Teicoplanin for perioperative antibiotic prophylaxis.
- To assess Teicoplanin's effectiveness in preventing deep prosthetic joint infections in elective total joint arthroplasty.
- To determine Teicoplanin serum and bone tissue concentrations during surgery.
Main Methods:
- A single intravenous dose of Teicoplanin (10 mg/kg) administered preoperatively to 111 patients undergoing elective total joint arthroplasty.
- 14-month follow-up for prosthetic device infections.
- Measurement of serum and bone tissue Teicoplanin concentrations in 16 patients.
- Identification of microbial isolates from superficial wound infections.
Main Results:
- No deep prosthetic device infections were observed during the 14-month follow-up.
- Superficial infections in two patients yielded S. epidermidis (methicillin-sensitive), Pseudomonas aeruginosa, and Enterobacter sp.
- Serum Teicoplanin levels remained within the therapeutic range during surgery.
- Bone tissue levels of Teicoplanin exceeded the MIC90 for methicillin-resistant strains.
Conclusions:
- A single preoperative dose of Teicoplanin is a safe and effective antibiotic prophylaxis for hip joint replacement.
- Teicoplanin demonstrates efficacy against common pathogens, including methicillin-resistant bacteria.
- This regimen is particularly valuable in the context of increasing antibiotic resistance.