Alexander Emil Kaspersen

Evaluation of single-dose cefuroxime concentrations in the spinal cord, cerebrospinal fluid and epidural space in relation to spine surgery: an experimental porcine study

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Background: Cefuroxime is used as surgical prophylaxis of intra- and extradural infections in relation to spine surgery. Bacterial eradication requires target tissue concentrations of cefuroxime above minimum inhibitory concentrations (MICs) of relevant pathogens for a sufficient amount of time. Microdialysis can continuously sample local antibiotic tissue concentrations in vivo and measure cefuroxime concentrations in intra- and extradural tissues.
Aim: To quantify concentrations of cefuroxime in intradural (spinal cord, cerebrospinal fluid) and extradural (epidural space) compartments in the lumbar spine of a porcine model using microdialysis.
Materials and Methods: Eight female pigs were anaesthetised and laminectomised at L3-4 by a posterior open surgical approach. Microdialysis catheters were placed for sampling in the spinal cord, cerebrospinal fluid, and epidural space. Cefuroxime (1500 mg) was administered intravenously over 10 minutes. Microdialysates and plasma were obtained continuously over 8 hours. Cefuroxime concentrations were determined by ultra-high performance liquid chromatography. The primary endpoint was time above cefuroxime clinical breakpoint MIC for Staphylococcus aureus (T>MIC of 4 µg/ml), and was compared between compartments using mixed effect-models and post hoc pairwise t- tests.
Results: Mean T>MIC (4 µg/ml) with 95% confidence interval (CI) were 58 (15–102), 0 (0–0), 115 (85–145), and 123 (106–141) minutes in spinal cord, cerebrospinal fluid, epidural space, and plasma, respectively. Tissue penetration (AUCtissue/AUCplasma) with 95% CI were 0.32 (0.13–0.51), 0.09 (0.03–0.15), and 0.63 (0.43–0.83) for spinal cord, cerebrospinal fluid, and epidural space, respectively. T>MIC (4 µg/ml) as well as tissue penetration were lower for the intradural compartments compared to the extradural.
Interpretation / Conclusion: Cefuroxime concentrations and T>MIC (4 µg/ml) were lower in intradural compartments compared to extradural, suggesting a compromising effect of the blood-brain barrier. In terms of T>MIC, single-dose cefuroxime (1500 mg) is inadequate for surgical prophylaxis of intradural infections, but adequate for surgical prophylaxis of extradural infections in spine surgery lasting a maximum 85 minutes.
Original languageEnglish
Publication year2021
Publication statusPublished - 2021
EventDanish Spine Society Annual meeting 2021 - Kolding, Denmark
Duration: 29 Oct 202129 Oct 2021


ConferenceDanish Spine Society Annual meeting 2021
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