Summary
The aim of this trial was to compare a 5-day course of cephazolin with a regimen of 2 days of cefamandole in 965 total hip replacements (488 in the cefamandole group and 477 in the cephazolin group). The effect of the prophylactic antibiotic on the bacterial colonization of drains (mean duration of drainage: 3.2±0.3 days) and on the susceptibility of colonizing organisms was assessed. No significant difference was observed in the percentage of infected drains between the two groups. The cefamandole group had a lower rate of Gram-negative organisms (23% versus 44%, p<0.01). The rate of deep infections within one year after operation was 0.7% in the cefamandole group versus 0.5% in the cephazolin group, and the difference is not significant. Cefamandole given for two days appears to be an effective prophylaxis against sepsis in total hip replacements.
Résumé
Dans un précédent travail les auteurs ont démontré l'efficacité d'une antibioprophylaxie de 5 jours par la céfazoline, comparativement à un placebo. Le but de cette nouvelle étude, réalisée par le même groupe de recherche, est de comparer un traitement de 5 jours par la céfazoline à un traitement de 2 jours par le céfamandole. 965 arthroplasties totales de hanche, sur 912 malades, ont été réalisées, 488 dans le groupe céfamandole et 477 dans le groupe céfazoline. On a évalué l'influence de l'antibioprophylaxie sur la contamination des drains de Redon (laissés en place 3.2±0,3 jours en moyenne) et sur la sensibilité des bactéries de contamination. On n'a pas trouvé entre les deux séries de différence significative du nombre des drains contaminés. Il y avait moins de bactéries Gram négatif dans le groupe céfamandole (23% contre 44%, p<0,05) et moins de germes résistant à l'antibiotique utilisé (30% contre 61%, p<0,01). Avec un an de recul le pourcentage d'infections profondes était de 0,7 dans le groupe céfamandole et de 0,5 dans le groupe céfazoline, différence non significative. La prophylaxie par 2 jours de céfamandole paraît donc efficace vis à vis des complications septiques de l'arthroplastie totale de hanche.
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Clinicians taking part were members of the Groupe d'Etude du Traitement Préventif de l'Infection dans les Arthroplasties: M. Bombart (Villeneuve-Saint-Georges), P. Desche (Dracy-le-Fort), D. Goutallier (Créteil), J. Guegen (Cannes), J. F. Kouvalchouk (Suresnes), M. Margeot (Clamart), F. Mazas (Bicêtre), J. Y. Nordin (Bobigny), D. Patte (Melun), M. Postel (Paris), D. Schmitt (Nancy)
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Evrard, J., Doyon, F., Acar, J.F. et al. Two-day cefamandole versus five-day cephazolin prophylaxis in 965 total hip replacements. International Orthopaedics 12, 69–73 (1988). https://doi.org/10.1007/BF00265744
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DOI: https://doi.org/10.1007/BF00265744