Category: Antibiotic

Introduction

Varied body regions have varying amounts of surgical site infections following damage or reconstructive surgery. Closure fracture surgeries and initial arthroplasty complication rates are reduced by antibiotic prophylaxis. Prophylactic antibiotics must be present in adequate quantities at the surgical site in order to avoid complications.

Research Question

• What are the cefazolin intended levels following orthopedic surgery in the limbs?
• How do the specific site level and cefazolin dosage affect the location of a particular area?

The objective of the given systematic review was to answer the questions regarding the concentration of cefazolin and its dosage. No aims and rationale were discovered during the analysis.

Study Design

Cephalosporins, orthopedics, extremities, surgical techniques, and pharmacokinetics were among the search terms used. RCTs or prospective cohort studies examining target site antimicrobial levels in human, mature participants who received prophylactic cefazolin in an IV injection dose prior to orthopedic or trauma treatment of the limb were suitable for inclusion. After complete text filtering, 14 studies were finally incorporated into the comprehensive study.

Additional Population Criteria

Studies were eliminated according to the following criteria: population (when included, clients received restorative antimicrobial drugs up to a week prior to surgical procedure or had peripheral arterial ailment), invasion (cephalosporin instead of cefazolin), design of the study (evaluations or publications only obtainable as abstract), and conclusion (only serum concentrations evaluated).

Variables

The dependent variable is the body location of the patient. Meanwhile, the independent variable, which influences the aforementioned variable, is cefazolin, whose concentrations and dosages.

Results

Increased bone concentrations were observed after 2 g than previously in studies evaluating different dosages of cefazolin, although pooling findings did not reveal a statistically significant change.

Limitations to the Study

The majority of research used data that had been gathered before the year 2000, which frequently led to poor documentation and potentially outmoded analysis techniques. Additionally, selection bias might well have arisen since only reasonably healthy patients were included in the majority of trials, which only comprised choice orthopedic surgery. Furthermore, less than half of the data could be pooled due to the significant variation in the sampling techniques, computation, and analysis. Third, patient or surgical factors might affect antibiotic target location levels. Overall, with emphasis solely on soft tissue samples and outdated materials, the paper might be subjective and less reliable.

Conclusions

I would not use this information at HSS due to its outdated and limited sample. The population is too narrow for HSS, yet the results of the observations might be clinically significant. As it was a systematic review that used evident models, it would be possible to replicate the study without contacting the author.

Reference

Sanders, F. R., Goslings, J. C., Mathôt, R. A., & Schepers, T. (2019). Target site antibiotic concentrations in orthopedic/trauma extremity surgery: Is prophylactic cefazolin adequately dosed? A systematic review and meta-analysis. Acta Orthopaedica, 90(2), 97-104.

The first mechanism by which antimicrobial agents work is the use of antibiotics. According to the nature of the action of antibiotics on bacteria they can be divided into two groups: bacteriostatic antibiotics and bactericidal antibiotics. Bacteriostatic are able to decrease the quantity of microbes, but they are unable to kill all of them. However, in higher concentrations bacteriostatic antibiotics can also have a bactericidal effect.

The next mechanism is temperature effects, which for the most part is used for sterilization – complete removal of microorganisms from various media and disinfection of objects. Many sterilization regimes have been developed; it should be remembered that heat treatment is applicable only to heat-resistant materials, for example, glass, metals (Sass, 2018). The simplest and most accessible methods are incineration and boiling.

The third method is treatment by radiation, an alternative to disinfection by gas. This method applies to all objects that do not change their properties under the influence of radiation. Two types of radiation – gamma and beta – are used for this treatment. In most cases, cobalt-60 isotope is used for sterilization, which forms an optimal spectrum (Sass, 2018). Finally, antiseptic is one of the most widespread and accessible methods of treatment and prevention of local infectious processes and sepsis. Currently used antiseptics can be divided into three groups according to their source: l) chemical elements and their inorganic derivatives; 2) bioorganic compounds and their synthetic derivatives; 3) organic compounds of abiogenic nature (Sass, 2018). Examples of antiseptic effects are halogens and their non-organic derivatives, hydrogen peroxide, potassium permanganate, boric acid and borates.

As part of sterilization, which involves the widespread destruction of microbes, burning in the flame of a burner or spittoon is the most effective. This method destroys not only plant cells but also microorganism spores, allowing the object to be completely desquamated. Bacterial analysis uses loops, spatulas, slides, coverslips, and other small instruments.

Reference

Sass, P. (2018). Antibiotics: Methods and Protocols. Methods in Molecular Biology.

Introduction

There are many severe issues and challenges in healthcare, and surgical site infections (SSIs) are among them. While the risks of SSIs can be declined and taken under control with the help of antibiotic prophylaxis, such as cefazolin, specific concerns or gaps exist. For example, if the concentrations of antibiotics in the surgery location are insufficient, infections cannot be prevented properly. According to Sanders et al. (2019), “dosage recommendations and the corresponding efficacy are unclear,” so the purpose of the authors is to address this gap (p. 97).

Methodology and Limitations

First of all, it is essential to provide basic information about the article’s methodology. To draw conclusions, the authors conducted a literature review: out of 825 studies, they included 14 papers in the systematic reviews and 5 articles in a meta-analysis (Sanders et al., 2019). Several limitations existed, including the varying quality and relevance of the selected studies, possible selection bias, and the low number of results to be pooled. As for future studies, “further research should investigate whether a higher dose of cefazolin can lead to higher concentrations and fewer SSIs,” as well as consider all the limitations (Sanders et al., 2019, p. 97).

Findings

Despite the low ability to pool the results, as well as the insignificance of some differences, the authors describe some valuable findings. First, “the concentrations lower or just above the MIC were all measured after administration of 1 g of cefazolin,” while when administering 2 g, higher bone concentrations were achieved (Sanders et al., 2019, pp. 97, 101). Second, concentrations in the hip were greater than in the knee. Third, “the concentrations that were lower or only just above the MIC were measured either more than 100 minutes after administration or in the foot” (Sanders et al., 2019, pp. 101). When comparing concentrations in soft tissues versus bones, the authors could not pool the results from the different articles as they varied greatly.

Discussion and Implications for Clinical Practice

Finally, it is possible to discuss the findings and see whether they bring any value or certainty to the clinical practice. The results of the literature review can be interpreted the following way: not only the concentration but also the time when it is higher than the MIC matters. Consequently, antibiotic prophylaxis works properly if it lasts at least during the ‘decisive period’ (Sanders et al., 2019, pp. 102). When samples are taken at multiple time points, they can be used to predict levels of antibiotics in tissue over time to improve healthcare knowledge and patient outcomes.

Further, the authors state that the same dosage of cefazolin does not lead to similar concentrations in different target sites. For example, as stated earlier, 1 g of cefazolin shows a higher concentration in the hip than in the knee, but it is yet to find out whether a higher dosage is beneficial in the extremity’s more distal parts. Finally, it is important to notice that a ceiling effect s expected. Nowadays, higher concentrations of antibiotics help reduce the risks of SSIs, but the authors expect that antimicrobial resistance can occur at a certain time.

Conclusion

To draw a conclusion, one may say that the article fulfills the gap in the topic to some extent. Indeed, further investigations and additional analyses are required, as stated by the authors, but this study adds to the existing knowledge (Sanders et al., 2019). Medical workers need to pay increased attention to the dosages of administered antibiotics aimed at reducing the risks of surgical site infections. While 1 g may not be enough to reach high concentrations during surgery of the more distal parts of the extremity, it is not explored whether higher dosages are safe. Since the reviewed articles provided varied information on concentrations in soft tissues and bones, this area also needs further discussions. Overall, Sanders et al. (2019) prove that concentrations depend on the dosages administered, and the location of the target site also matters.

Reference

Sanders, F. R. K., Goslings, J. C., Mathôt, R. A. A., & Schepers, T. (2019). Target site antibiotic concentrations in orthopedic/trauma extremity surgery: Is prophylactic cefazolin adequately dosed? A Systematic Review and Meta-Analysis, Acta Orthopaedica, 90(2), 97-104.

Since their discovery, antibiotics have been used to kill bacteria. Such biologically active substances have additionally been employed in a wide range of other medical procedures. Antibiotics have undoubtedly benefited human civilization by saving countless lives in the fight against microorganisms. Numerous bacterial illnesses are treated with antibiotics. Nevertheless, as long as antibacterial medications are utilized to treat bacterial infections, bacteria continue to grow and employ resistance methods, such as genetic code exchange, agriculture, or antibiotic misuse.

Bacteria are living organisms that change throughout time, and their primary goal is to multiply, persist, and spread as quickly as possible. Genetic code exchange is one method the bacterium acquires resistance to antibiotics. A variant that was once vulnerable may now have gained resistance from some other family or genus (Uddin et al. 1754). Most of the genes that cause antibiotic resistance are found on mobile DNA components, which can and frequently do transfer to bacteria of various species and types (Uddin et al. 1754). A replica of the DNA from drug-resistant microorganisms could be transferred to non-resistant organisms. The bacteria that are not drug-resistant build new genes and become resistant to drugs. However, sometimes the reason behind bacteria developing resistance to antibiotics is the patient’s negligent medication use. Excessive and insufficient usage of antibiotics by a person is another way bacteria produce resistance (Uddin et al. 1755). Certain microorganisms may survive and acquire resistance to medication if a patient does not complete antibiotic treatment.

Lastly, a substantial application of antibiotics in agriculture can aid bacteria in building resistance. Antibiotics are utilized as synthetic chemicals and growth enhancers for livestock in industrialized and developing regions (Uddin et al. 1754). Similar to antibiotic use in people, it causes the emergence of antibiotic-resistant microorganisms in animals as well (Uddin et al. 1754). The organisms resistant to antibiotics found in cattle can be harmful to humans, are easily transferred from animals to people through food sources, and are widely dispersed in the environment by animal waste.

Hence, bacteria continue to develop and use resistance strategies as long as antibacterial drugs are used to treat bacterial illnesses. One process by which the bacteria develops antibiotic resistance is genetic code exchange. Sometimes a patient’s careless medicine usage causes microorganisms to become resistant to antibiotics. Lastly, using a lot of antibiotics in agriculture might help bacteria develop resistance since antibiotics’ reactions in animals might be similar to one in humans.

Work Cited

Uddin, Tanvir Mahtab, et al. “Antibiotic Resistance in Microbes: History, Mechanisms, Therapeutic Strategies and Future Prospects.” Journal of Infection and Public Health, vol. 14, no. 12, 2021, pp.1750-1766.

Worrying about the developing degree of medication-safe microscopic organisms has prompted the forbidding of sub-helpful utilization of anti-infection agents in meat in many nations. In the United States, nonetheless, such use is still legitimate. The rise of a safe strain of the microbes is just a question of time because anti-toxins were regularly used to treat livestock. Then, at that point, if safe strains of microscopic organisms show up in livestock, they can be spread to people through tainted meat. Commensal microorganisms found in animals are often present in new meat items. They may fill in as supplies for safe qualities that might move to pathogenic living beings in people.

There is some proof to demonstrate that the anti-toxins kill the vegetation that would regularly flourish in the animals’ digestive organs, permitting them to use their food all the more adequately (Public Broadcasting Service, n.d.). Consequently, ranchers began directing small dosages of anti-microbials day by day. This expansion represents a huge danger to the viability of anti-infection medications (NPR, 2001). Denmark keeps up with exceptionally low degrees of anti-microbial utilization incompletely through a blend of good practices for domesticated animals’ well-being and administrative limitations (Public Broadcasting Service, n.d.). Normally, paces of anti-infection use are bigger for higher-pay countries and those with more elevated levels of meat utilization. Drug use in animals in wealthy countries like Norway, Sweden, and Denmark is restricted with successful guidelines.

With great farming practices and viable approaches, such models feature that fundamentally decreased anti-infection use can be accomplished close to profoundly useful agrarian areas. Danish specialists say U.S. ranchers, who frequently feed anti-infection agents to animals to keep away from diseases, can eliminate anti-microbial use by essentially cleaning domesticated animal pens consistently (NPR, 2001). There should be a general decrease in the utilization of all classes of restoratively significant anti-infection agents in food-delivering animals, including total limitation of these anti-microbials for development advancement and sickness counteraction without finding. Scientists propose that keeping up with somewhere in the range of 112 and 220 feet of distance between animals would restrict most spillover contamination across clay-rich soil lands common in the southeastern United States (Ma et al., 2019). Solid animals ought to possibly get anti-infection agents to forestall illness on the off chance it has been analyzed in different animals in a similar group, crowd, or fish populace.

Most anti-microbial use in animals requires a veterinary remedy, albeit individual treatment choices are regularly made and managed by lay homestead laborers as per rules given by a veterinarian. Despite the broad reception of anti-microbial use in food animals, credible information about the amount and examples of utilization are not accessible (Public Broadcasting Service, n.d.). Contingent upon the nature and ward of each gathering, there is a need to examine the rise of anti-infection obstruction. Similarly, there should be proposals for an administrative activity to control drug endorsement and observation measures or enforceable laws on antibiotic agent production dissemination and solution.

Deficient subsidizing for farming exploration has likely added to the absence of adequate logical proof essential for illuminating general wellbeing choices. Considering that the U.S. reserves 70% to 80% of biomedical examinations worldwide, the requirement for proper degrees of financing is particularly intense (Ma et al., 2019). Given the size of the anti-infection obstruction issue in the general wellbeing emergency, good help for research explicit to the rural employments of anti-infection agents in the advancement of opposition should be a public need.

References

NPR. (2001). How safe is the food supply? Kicking the habit of antibiotics on the farm. Web.

Public Broadcasting Service. (n.d.). Is your meat safe? – Antibiotic debate overview | modern meat | frontline. Web.