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.