You are on page 1of 17

Widiyatmiko A.P., Hermawan N.R., Ismiarto Y. D. Rahim, A.H.

Department of Orthopaedic and Traumatology


Faculty of Medicine Universitas Padjadjaran
Hasan Sadikin Hospital Bandung
2011
No consensus guidelines on
treatment is still based
antibiotic therapy for bone and
joint infections are currently on expert opinion
available

Antibiotic characteristic
-Invitro activity
Empiric Terapy - excelence bone penetration
-good tolerance

Cefazolin
Lazzarini L, Lipsky BA, Madder J. Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis. 2005;9(3):127-38.
Lew D, Waldvogel F. Osteomyelitis. Lancet. 2004;364(9431):369-79.
 semisynthetic cephalosporin with
good in vitro activity
 methicillin-susceptible staphylococci
 nonenterococcal streptococci

 Excellent tolerance

 Good Bone Difussion


Cunha, B. A., H. R. Gossling, H. S. Pasternak, C. H. Nightingale, and R. Quintiliani. 1977. The penetration characteristics of cefazolin, cephalothin, and cephradine
into bone in patients undergoing total hip replacement. J. Bone Joint Surg. Am. 59A:856-859
Cunha, B. A., H. R. Gossling, H. S. Pasternak, C. H. Nightingale, and R. Quintiliani. 1984. Penetration of cephalosporins into bone. Infection 12:80-84.
Fass, R. 1978. Treatment of osteomyelitis and septic arthritis with cefazolin. Antimicrob. Agents Chemother. 13:405-411
to evaluate the efectiveness of Cefazolin
administration for the treatment of chronic
osteomyelitis based on the bacterial culture and
resistencies test’s data from January 2009 –
December 2010 at Hasan Sadikin Hospital.
Retrospective study

2nd data December 2010


January 2009

sex age

Hospitalization length Data Source


Location of
infection
Medical Record
microbial pattern 2009-2010

Cefazolin
resistancy pattern
18%

Male = 27
82%

Female = 6
Age Number %
0 – 14 yo 5 15

15 – 35 yo 21 64

36 – 55 yo 5 15

> 55 yo 2 6

Total 33 100

people
Hospitalization length Number %

0 – 10 days 4 peoples 12

11-20 days 18 peoples 55

21-30 days 7 peoples 21

> 30 days 4 peoples 12

Total 33 peoples 100


percentage

25%
Cruris 13 px
39%
Femur 9 px
9% Humerus 3 px
Others 8 px

27%
Microorganism Operative specimen
Staphylococcus aureus 10
Staphylococcus haemoliticus 2
Pseudomonas aeruginosa 5
Alcaligenes faecalis 1
Burkholderia cepacia 2
Proteus mirabilis 2
Klebsiella pneumonia 2
Acinetobacter baumanii 1
Enterobacter aeruginosa 2
Morganella morganii 1
Staphylococcus epidermidis 3
Klebsiella terirgena 1
Prudencia stuartii 1
Total 33
16%

sensitif= 28
resisten =5
84%
 Cefazolin  used for >30 years to treat bone
and joint infections
 Good activity against gram-positive cocci especially
methicillin-susceptible staphylococci
 its excellent tolerance
 its low cost
 limited antimicrobial spectrum

Zeller V, Durand F, Kitzis D. Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum
and Bone Concentrations. Pub Med Central. 2009;53(3):883-7.
 The most common pathogen microorganism is S aureus

 Culture and resistancy result cefazolin is 84% sensitive

 The efficacy of cefazolin for the treatment of bone and


joint infections has been evaluated only once by Fass

(Hospital Episode Statistics, Department of Health, England, 2002-03)


Zeller V, Durand F, Kitzis D. Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy,
Feasibility, Safety, and Serum and Bone Concentrations. Pub Med Central. 2009;53(3):883-7.
Fass, R. 1978. Treatment of osteomyelitis and septic arthritis with cefazolin. Antimicrob. Agents Chemother. 13:405-411
 empiric treatment using cefazolin for chronic
osteomyelitis is still efective, especially in
Hasan Sadikin
 To prevent the rising of antibiotic
resistencies, we should give antibiotic based
on right indication and diagnosis
 1. Solomon L, Srinivasan H, Tuli S, Govender S. Infection. In: Nayagam, Solomon, Warwick,
editors. Apley's Textbook Of Orthopaedic. London: Hodden Arnold; 2010. p. 29-42.
 2. Mader J, Mohan D, Calhoun J. A Practical Guide to Diagnosis and Management of Bone and
Joint Infection. Drugs. 1997;54(2):253-64.
 3. Kaur J, Gulati V, Aggarwal A, Gupta V. Bacteriological Profile of Osteomyelitis with Special
Reference to Staphylococcus aureus. Indian Journal. 2008;4(6):1-2.
 4. Setiawan A, Ismiarto YD, Widya A. Perbandingan Organisme Yang Di Isolasi Secara Swab
Superfisial Dan Debridemen Intraoperatif Pada Osteomyelitis Kronis COE Pekanbaru. 2010.
 5. Ciampolini, Harding KG. Pathophysiology of chronic bacterial osteomyelitis. Why do
antibiotics fail so often? Postgrad Med J. 2000;76:479-83.
 6. Perry CR, Pearson RL, Miller GA. Accuracy of cultures of material from swabbing of the
superficial aspect of the wound and needle biopsy in the preoperative assessment of
osteomyelitis. J Bone Joint Surg Am. 1991;73:745-9.
 7. Mackowiak PA, Jones SR, Smith JW. Diagnostic Value of Sinus-tract Cultures in Chronic
Osteomyelitis. JAMA. 1978;239(26).
 8. Zeller V, Durand F, Kitzis D. Continuous Cefazolin Infusion To Treat Bone and Joint
Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations. Pub Med
Central. 2009;53(3):883-7.
 9. Minerjad R, Fallahi S, Kiani J, Khoobdel M, Jonaidi N, Allaedini F. Epidemic Assessment of
Bacterial Agents In Osteomyelitis and Their Antibiotic Resistance Pattern Determination. Journal
of Biological Sciences. 2008;8(2):478-81.
 10. Lazzarini L, Lipsky BA, Madder J. Antibiotic treatment of osteomyelitis: what have we
learned from 30 years of clinical trials? Int J Infect Dis. 2005;9(3):127-38.
 11. Lew D, Waldvogel F. Osteomyelitis. Lancet. 2004;364(9431):369-79.
 12. Barberan J. Management of infections of osteoarticular prosthesis. Clin Microbiol
Infect. 2006;12(3):93-101.
 13. Mandracchia V, Sanders S, Jaeger A, Nickles W. Management of Osteomyelitis. Clin
Podiatr Med Surg. 2004;21(3):335-51.
 14. Hart J. Musculoskeletal Infection. In: Miller M, editor. Review of Orthopaedics.
Philadelphia: Saunders Elsevier; 2008. p. 83-5.
 15. Canale S, Beaty J. Chronic Osteomyelitis. Campbell's Operative Orthopaedics.
philadelphia: Mosby Inc.; 2007.
 16. Smeltzher M, Nelson C. Osteomyelitis. In: Honeyman A, Friedman H, Bendinelli M,
editors. Staphylococcus aureus Infection and Disease
 New York: Kluwer Academic Publishers; 2002.
 17. Covey D. Combat orthopaedics: a view from the trenches. J Am Acad Orthop Surg.
2006;14(5):10-7.
 18. Rahbar M, N NB, Yadgarinia D, Mohammadzadeh M. Etiology and Drug Resistance
Pattern of Osteomyelitis Associated with Combat-Related Injuries in Iraqi Patients. Shiraz
E-medical Journal. 2010;11(2):73-8.
 19. Fass, R. 1978. Treatment of osteomyelitis and septic arthritis with cefazolin.
Antimicrob. Agents Chemother. 13:405-411