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Antimicrobial Agents and Chemotherapy, March 2009, p. 883-887, Vol. 53, No. 3
0066-4804/09/$08.00+0     doi:10.1128/AAC.00389-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations{triangledown}

Valérie Zeller,1,2* Frédérick Durand,1,2 Marie-Dominique Kitzis,3 Luc Lhotellier,1 Jean-Marc Ziza,2 Patrick Mamoudy,1 and Nicole Desplaces1,4

Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France,1 Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France,2 Laboratoire de Microbiologie, Groupe Hospitalier Paris Saint-Joseph, 68, rue des Plantes, Paris 75014, France,3 Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France4

Received 22 March 2008/ Returned for modification 30 April 2008/ Accepted 3 December 2008

Cefazolin has been used for many years to treat bone and joint infections. Because of its time-dependent antimicrobial activity, continuous infusion would potentially be beneficial. We report on the feasibility, safety, and efficacy of prolonged continuous intravenous cefazolin therapy in a cohort of 100 patients, their serum cefazolin levels, and the concomitant bone cefazolin concentrations in 8 of them. This retrospective cohort study included all the patients treated for bone or joint infection with a continuous cefazolin infusion administered over a 12-h period twice daily for ≥2 weeks. Drug monitoring was performed at least twice for all the patients. Serum and bone cefazolin concentrations were determined by standardized disk diffusion microbiological assays. The absence of clinical, biological, and radiological signs of infection after 2 years of follow-up and the same criteria after 1 year of follow-up defined cures and probable cures, respectively. The median treatment duration was 42 days, and the median daily cefazolin dose was 6 g. Half of the patients received parenteral antibiotic therapy on an outpatient basis. Two moderate-grade adverse events were observed. The median serum cefazolin concentrations were 63 µg/ml (range, 13 to 203 µg/ml) and 57 µg/ml (range, 29 to 128 µg/ml) on days 2 to 10 and days 11 to 21, respectively. The median bone cefazolin concentration reached 13.5 µg/g (range, 3.5 to 29 µg/g). The median bone concentration/serum concentration ratio was 0.25 (range, 0.06 to 0.41). Among 88 patients with a median follow-up of 25 months (range, 12 to 53 months), 52 were considered cured and 29 were considered probably cured. Thus, the treatment of bone and joint infections with a prolonged continuous intravenous cefazolin infusion was feasible, effective, well-tolerated, safe, and convenient, making it a strong candidate for home therapy.

* Corresponding author. Mailing address: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France. Phone: 33144641694. Fax: 33144643337. E-mail: vzeller{at}hopital-dcss.org

{triangledown} Published ahead of print on 15 December 2008.

Antimicrobial Agents and Chemotherapy, March 2009, p. 883-887, Vol. 53, No. 3
0066-4804/09/$08.00+0     doi:10.1128/AAC.00389-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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