Data demonstrating that antibiotics administered intraoperatively in patients with surgical revision for periprosthetic joint infection achieve concentrations exceeding minimal inhibitory concentrations of the identified bacteria at the surgical site when the new implant is inserted are lacking. We prospectively included patients with periprosthetic joint infection operated with one- or two-stage replacement during which cefepime (2g)-daptomycin (10mg/kg) combination was administered intravenously as intraoperative empirical antibiotic treatment. Three biopsies (two bones and one synovial membrane) were taken from each patient just before the insertion of the new implant. Eighteen adults of median age 68 years were included. Knee was involved in 10 patients (55.6%) and surgery consisted in one-/two-stage replacement in 11/7 patients. A tourniquet was used during the intervention in the 10 patients with knee prosthesis. Among 54 tissue samples, cefepime and daptomycin were detected respectively in 35 (64.8%) and 21 (38.9%) cases (P=0.01). A total of 17 bacteria dominated by staphylococci (n=14) were identified in 10 patients; tissue inhibitory quotient calculated in 51 samples was >1 in 22 cases (43.1%) for cefepime and in 16 cases (31.4%) for daptomycin. The proportion of tissue samples with detectable antibiotic was significantly higher in hip versus knee prosthesis (P=0.03). The present study suggests that intraoperative empirical administration of cefepime-daptomycin combination during septic prosthetic joint replacement results in a high proportion of tissue samples in which at least one of the two antibiotics was not detected or at a low concentration despite satisfactory concomitant blood serum concentrations.

缺乏数据表明，在植入新植入物时，因假体周围感染而进行手术翻修的患者术中使用抗生素达到的浓度超过了手术部位已识别细菌的最小抑制浓度。我们前瞻性地纳入了一期或二期置换手术的假体周围关节感染患者，在此期间静脉内给予头孢吡肟 (2g)-达托霉素 (10mg/kg) 组合作为术中经验性抗生素治疗。在插入新植入物之前，对每位患者进行了三份活组织检查（两块骨头和一块滑膜）。包括 18 名中位年龄为 68 岁的成年人。10 名患者 (55.6%) 膝关节受累，11/7 名患者的手术包括一期/二期置换。10 例膝关节假体患者在干预过程中使用了止血带。在54份组织标本中，分别检出头孢吡肟和达托霉素35例（64.8%）和21例（38.9%）（P=0.01）。10例患者共鉴定出以葡萄球菌为主的17种细菌（n=14）；在 51 个样本中计算的组织抑制商数在 22 例 (43.1%) 的头孢吡肟和 16 例 (31.4%) 的达托霉素中 >1。与膝关节假体相比，髋关节假体中含有可检测抗生素的组织样本比例显着更高（P=0.03）。