Pharmacokinetics of Cefuroxime in Traumatic Wound Secretion and Antibacterial Activity Under Vacuum Therapy

Abstract The objective of this study was to investigate the pharmacokinetics of cefuroxime in wound secretion and the antibacterial activity of the traumatic wound secretion inpatients receiving cefuroxime and in those not receiving antibiotics. Included in the present controlled, prospective, non-randomized study were 12 patients with an open fracture who needed vacuum therapy (group A) and 12 patients with a closed fracture, who, due to soft tissue damage, also underwent treatment with vacuum therapy (group b). Wound secretion was obtained on the first, third and fifth postoperative days and exposed to the test bacteria, Staphylococcus aureus and Staphylococcus epidermidis. Patients in group A underwent systemic antibiotic treatment with cefuroxime administered intravenously at a dose of 1.5 g every 8 hours. Patients in group b did not receive antibiotics. Cefuroxime concentrations were determined using high-performance liquid chromatography (HPLC). Antibacterial activity was deter-mined using the inhibition test. Maximum cefuroxime concentrations in wound secretion were measured at 4-5 hours following intravenous administration and, with a mean concentration of 10 mg/L, remained consistently above the minimum inhibitory concentration (MIC) for the test bacteria at all points during the measurement period. As expected, the antibacterial activity of the wound secretion in patients in group A (cefuroxime) was higher than that in group b (no antibiotics). In group A, antibacterial activity against S. aureus was 94.6% and 100% against S. epidermidis. In group B, antibacterial activity against S. aureus was 61% and 81% against S. epidermidis. Cefuroxime reaches the highest level in wound secretion after 4 hours. The high antibacterial activity of the wound secretion in traumatic closed fractures is elevated by cefuroxime. In addition, our findings show that vacuum therapy of wounds is suitable as anon-invasive method for studying the pharmacokinetics of antibiotics.

[1]  U. Becker,et al.  Vacuum sealing: indication, technique, and results , 1995, European Journal of Orthopaedic Surgery & Traumatology.

[2]  L. Kinzl,et al.  Physikalische Untersuchungen zur Vakuumtherapie , 2005 .

[3]  M. Koot,et al.  High pressure liquid chromatographic analysis of the serum concentration of cefuroxime after an intravenous bolus injection of cefuroxime in patients with a coronary artery bypass grafting , 1992, Pharmaceutisch Weekblad.

[4]  C. Stratton,et al.  Effect of human serum on inhibition of growth ofStaphylococcus aureus by antimicrobial agents , 1986, European Journal of Clinical Microbiology.

[5]  C. Stratton.  Standardization of the serum bactericidal test and its relationship to levels of antimicrobial agents , 1986, European Journal of Clinical Microbiology.

[6]  R. Ketterl,et al.  Einsatzmöglichkeiten des Basiscephalosporins Cefuroxim in der Knochenchirurgie Gewebespiegel, Wirksamkeit und Verträglichkeit , 2005, Infection.

[7]  L. Kinzl,et al.  [The physics of vacuum therapy]. , 2005, Zentralblatt fur Chirurgie.

[8]  G. Halter,et al.  Vacuum-sealed mesh graft transplantation in chronic cutaneous ulcers of the lower leg. , 2003, VASA. Zeitschrift fur Gefasskrankheiten.

[9]  R. Kreis.  Vacuum-sealing fixation of mesh graft transplants , 2003, European Journal of Plastic Surgery.

[10]  G. Halter,et al.  Vacuum-sealing fixation of mesh grafts , 2003, European Journal of Plastic Surgery.

[11]  M. Czerny,et al.  The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. , 2002, The Annals of thoracic surgery.

[12]  M. Marks,et al.  The Use of Vacuum‐Assisted Closure Therapy for the Treatment of Lower‐Extremity Wounds with Exposed Bone , 2001, Plastic and reconstructive surgery.

[13]  G. Rodriguez,et al.  Vacuum-assisted closure for cutaneous gastrointestinal fistula management. , 2001, Gynecologic oncology.

[14]  R. Burns,et al.  Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. , 1999, The Journal of trauma.

[15]  L. Kinzl,et al.  Antibiotikaprophylaxe und Therapie in der Unfallchirurgie , 1999, Der Unfallchirurg.

[16]  L. Kinzl,et al.  [Antibiotic prophylaxis and therapy in trauma surgery]. , 1999, Der Unfallchirurg.

[17]  G. Bannister,et al.  A comparison of the penetration of cefuroxime and cephamandole into bone, fat and haematoma fluid in patients undergoing total hip replacement. , 1997, The Journal of antimicrobial chemotherapy.

[18]  L. Argenta,et al.  Vacuum‐Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation , 1997, Annals of plastic surgery.

[19]  V. Vécsei,et al.  The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. , 1997, British journal of plastic surgery.

[20]  W. Fleischmann,et al.  Infektbehandlung durch Vakuum-versiegelung , 1997, Der Unfallchirurg.

[21]  M. Hansis,et al.  [Prophylactic and therapeutic use of antibiotics in trauma surgery]. , 1996, Der Unfallchirurg.

[22]  D. Holt,et al.  A high performance liquid chromatography system for the simultaneous assay of some antibiotics commonly found in combination in clinical samples. , 1990, The Journal of antimicrobial chemotherapy.

[23]  C. Stratton,et al.  Correlation of serum bactericidal activity with antimicrobial agent level and minimal bactericidal concentration. , 1982, The Journal of infectious diseases.

[24]  R. Kester,et al.  Cefuroxime levels attained in tissues and wound exudates from severely ischaemic limbs. , 1981, The Journal of antimicrobial chemotherapy.

[25]  Ronald N. Jones,et al.  Cefuroxime, a New Parenteral Cephalosporin: Collaborative In Vitro Susceptibility Comparison with Cephalothin Against 5,887 Clinical Bacterial Isolates , 1977, Antimicrobial Agents and Chemotherapy.

[26]  R. Foord.  Cefuroxime: Human Pharmacokinetics , 1976, Antimicrobial Agents and Chemotherapy.