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
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