Alexander Emil Kaspersen

Heterogenous cefuroxime penetration to the anterior and posterior column of the spine: An experimental porcine study

Research output: Contribution to conferenceConference abstract for conferenceResearchpeer-review

Background: Postoperative infection following spine surgery can have devastating complications. Perioperative antibiotic prophylaxis plays a key role in lowering the risk of acquiring an infection. The antibiotic target tissue concentrations should, as a minimum, exceed relevant minimal inhibitory concentrations (MIC) for the duration of the surgery in all exposed tissues. Previous studies have primarily measured antibiotic concentrations in the anterior column (AC) of the spine, however the majority of spine surgeries are performed in the posterior column (PC) of the spine.
Aim: The objective of this study was to compare the perioperative tissue concentrations of cefuroxime in the AC and PC in posterior open lumbar spine surgery.
Materials and Methods: Posterior open lumbar spine surgery was conducted on 8 female pigs. Microdialysis catheters were placed for sampling in the AC (vertebral body) and PC (posterior arch) within the same vertebrae (L5). Cefuroxime (1.5 g) was administered intravenously over 10 min and microdialysates and plasma samples were continuously obtained over 8 hours. Cefuroxime concentrations were quantified by Ultra High-Performance Liquid Chromatography. The primary endpoint was time above cefuroxime clinical breakpoint MIC for Staphylococcus Aureus (T>MIC (4 µg/mL)).
Results: Mean T>MIC (4 µg/mL) [95%CI] were 104 [85–123], 93 [73-112] and 123 min [104-142] in the AC, PC and plasma, respectively. Tissue penetration (AUCtissue/AUCplasma) [95%CI] was incomplete for both the AC (0.53 [0.42 - 0.64]) and PC (0.36 [0.25-0.47]) with the lowest penetration to the PC (p=0.048). Area under the concentration-time curve from 0 to last measured value (AUC0-last) was higher in the AC compared with the PC (p=0.05).
Interpretation / Conclusion: Cefuroxime penetrated heterogeneously within the same vertebrae, but the T>MIC were comparable between the anterior and posterior column. The mean cefuroxime concentrations decreased below 4 µg/mL after 93 min (PC) and 104 min (AC) after a single dose administration. This is shorter than the duration of most spine surgeries, and therefore alternative dosing regimens should be considered in posterior open lumbar spine surgeries lasting more than 90 min.
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
Internet address

See relations at Aarhus University Citationformats

ID: 225767759