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Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration.

Publication ,  Journal Article
Byers, IS; Turner, NA; Levine, NL; Lazarides, AL; Evans, DR; Spasojevic, I; Fan, P; Jung, S-H; Gao, J; Visgauss, JD; Brigman, BE; Eward, WC
Published in: Antimicrob Agents Chemother
October 18, 2022

In orthopedic oncology, the implant of a megaprosthetic device is standard of care after large-scale tumor resection involving segmental removal of bone. Infection remains the leading cause of implant failure, often resulting in major morbidity. Perioperative antibiotic practices for megaprosthetic reconstructions are not standardized and are based on guidelines for conventional joint arthroplasties. This study aims to evaluate the efficacy of current prophylactic strategies for megaprosthetic reconstructions. We conducted a retrospective review of megaprosthetic reconstructions performed at Duke University from 2001 to 2021. Logistic regression with GEE was used to assess whether a prolonged course of postoperative antibiotics is associated with infection risk. We assessed the microbial profile and corresponding susceptibilities of megaprosthetic infections through record review. Additionally, we designed a pharmacokinetic subgroup analysis using liquid chromatography-tandem mass spectrometry to quantify antibiotic concentrations in surgical tissue. Wilcoxon rank-sum tests were used to correlate tissue concentrations with infection risk. Out of 184 cases, 23 (12.5%) developed infection within 1 year. Extended postoperative antibiotics were not significantly associated with infection risk (P = 0.23). Among 18 culture-positive cases, 4 (22.2%) were caused by cefazolin-susceptible organisms. Median bone and muscle concentrations of cefazolin among cases that developed postoperative infection (0.065 ng/mL and 0.2 ng/mL, respectively) were significantly lower than those of cases that did not (0.42 ng/mL and 1.95 ng/mL, P < 0.01 and P = 0.03). This study is the first to comprehensively assess aspects of perioperative prophylaxis for megaprosthetic reconstructions. Extending postoperative antibiotics did not reduce infection risk. We detected a high frequency of cefazolin nonsusceptible organisms among postoperative infections. Additionally, intraoperative antibiotic tissue concentrations may be predictive of later infection. Future studies ought to examine optimal drug choices and dosing strategies.

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Published In

Antimicrob Agents Chemother

DOI

EISSN

1098-6596

Publication Date

October 18, 2022

Volume

66

Issue

10

Start / End Page

e0014022

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Retrospective Studies
  • Microbiology
  • Humans
  • Cefazolin
  • Antibiotic Prophylaxis
  • Anti-Bacterial Agents
  • 3214 Pharmacology and pharmaceutical sciences
  • 3207 Medical microbiology
  • 3107 Microbiology
 

Citation

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ICMJE
MLA
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Byers, I. S., Turner, N. A., Levine, N. L., Lazarides, A. L., Evans, D. R., Spasojevic, I., … Eward, W. C. (2022). Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration. Antimicrob Agents Chemother, 66(10), e0014022. https://doi.org/10.1128/aac.00140-22
Byers, Isabelle S., Nicholas A. Turner, Nicole L. Levine, Alexander L. Lazarides, Daniel R. Evans, Ivan Spasojevic, Ping Fan, et al. “Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration.Antimicrob Agents Chemother 66, no. 10 (October 18, 2022): e0014022. https://doi.org/10.1128/aac.00140-22.
Byers IS, Turner NA, Levine NL, Lazarides AL, Evans DR, Spasojevic I, et al. Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration. Antimicrob Agents Chemother. 2022 Oct 18;66(10):e0014022.
Byers, Isabelle S., et al. “Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration.Antimicrob Agents Chemother, vol. 66, no. 10, Oct. 2022, p. e0014022. Pubmed, doi:10.1128/aac.00140-22.
Byers IS, Turner NA, Levine NL, Lazarides AL, Evans DR, Spasojevic I, Fan P, Jung S-H, Gao J, Visgauss JD, Brigman BE, Eward WC. Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration. Antimicrob Agents Chemother. 2022 Oct 18;66(10):e0014022.

Published In

Antimicrob Agents Chemother

DOI

EISSN

1098-6596

Publication Date

October 18, 2022

Volume

66

Issue

10

Start / End Page

e0014022

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Retrospective Studies
  • Microbiology
  • Humans
  • Cefazolin
  • Antibiotic Prophylaxis
  • Anti-Bacterial Agents
  • 3214 Pharmacology and pharmaceutical sciences
  • 3207 Medical microbiology
  • 3107 Microbiology