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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 50 - 50
1 Oct 2022
THE NEED FOR AN EARLY THERAPEUTIC DRUG MONITORING OF VANCOMYCIN CONCENTRATIONS FOR THE MANAGEMENT OF BONE AND JOINT INFECTIONS
Pardos SL No LR Arderiu A Redó MLS Prieto DP Junyent JG Verdie LP Fabrego AA Prim N Cerrato SG
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Aim

Vancomycin is frequently used for bone and joint infections (BJI) because of the main role of Gram-positive bacteria as potential causal agents. It is crucial to achieve optimal vancomycin plasma concentrations since the first day to maximize treatment clinical and microbiological efficacy. The aim was to describe the patients’ profile that are more likely to achieve an optimal pharmacokinetic/pharmacodynamics (PK/PD) vancomycin target in the first therapeutic drug monitoring (TDM) sample.

Methods

Retrospective study (March 2018-January 2022) in a university hospital including all patients treated with vancomycin for a BJI and undergoing TDM. Initial dose (1g/8-12h) was selected by the responsible clinician. Vancomycin plasma concentrations were obtained pre-dose (Cmin,ss) and 60-minutes after the infusion on day 2 of treatment. Global exposure measured by the area under the curve of plasma concentrations during 24h (AUC024h) was estimated using a bicompartmental PK model.

An AUC024h/CMI=400–600mg*h/L was considered optimal, <400 infratherapeutic and >600 supratherapeutic, based on recent guidelines, and patients were classified into these 3 groups. A value of CMI=1 mg/L was considered, following guidelines recommendations.

Categorial data: percentages and quantitative data as mean (standard deviation).

Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 86 - 86
1 Mar 2010
COMPARATIVE STUDY OF TISSUE CULTURE AND USE OF ULTRASOUND ON IMPLANTS IN THE DETECTION OF PROSTHETIC INFECTION
Adrover AM Lòpez XP Cuevas AG Gallego JH Redò LS Verdie LP
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Introduction and Objectives: Culture of periprosthetic tissue is the diagnostic treatment of reference in prosthetic infection (sensitivity 65–94%). The use of ultrasound to detach microorganisms attached to the implant may increase sensitivity.

Materials and Methods: We prospectively cultured in different media the ultrasound product of the implants (knee prosthesis, hip, osteosynthesis material (OM) and spine plates and screws) extracted in our center and we obtained 3–5 samples of periimplant tissue to cultivate in each case. The gold standard was the presence of pus, fistulas, acute inflammatory tissue in the histological study or presence of positive cultures with clinical concordance. We also assessed the use of antibiotics prior to surgery.

Results: We assessed 153 cases. Infections: 11 hip, 16 knee, 16 OM and 7 spine plates and screws. Conventional technique: there was a sensitivity of: 63% in hip prosthesis, 56% in knee, 81% OM and 71% in spinal plates and screws with a specificity of 94%, 100%, 98% and 100% respectively. With the use of ultrasound: there was a sensitivity of: 90% hip, 87% knee, 93% OM and 100% spine plates and screws. Specificity: 94%, 100%, 92% and 80% respectively. 13 patients received preoperative antibiotic treatment. With the use of ultrasound 10 were detected, with cultures 7. Both techniques were compared using the Fisher test. Ultrasound was more sensitive when a global prosthetic culture was done (p< 0.001) and in knee prosthesis (p< 0.04). No differences were seen with other implants.

Discussion and Conclusions: Culture after ultrasound had been applied was seen to be more sensitive than culture of conventional tissue. The use of ultrasound was more effective in patients that received prior treatment with antibiotics.