Cefazolin tissue concentrations with a prophylactic dose administered before sleeve gastrectomy in obese patients: a single centre study in 116 patients

Cinotti, Raphaël; Dumont, R.; Ronchi, L.; Roquilly, Antoine; Atthar, Vincent; Grégoire, Matthieu; Planche, Lucie; Letessier, E; Dailly, Éric; Asehnoune, Karim

doi:10.1016/j.bja.2017.10.023

Cited by 12 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Staphylococcus aureus is the main pathogen that causes surgical site infection when using cefazolin as antibiotic prophylaxis, 2,15 and the MIC breakpoint of this pathogen is 4 mg/L based on free concentration. [16][17][18][19] When considering f u , the target total concentration can be determined as Through the simulation, the target concentration at which the free concentration would be 4 mg/L or higher in most patients was numerically searched; as a result, if the target concentration was set to 100 mg/L, the free concentration was 4 mg/L or more in 97.5% of patients (Figure 3B,D).…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, the target total concentration was set to 100 mg/L when cefazolin was administered by the TCI method using a model constructed with total concentration data. Staphylococcus aureus is the main pathogen that causes surgical site infection when using cefazolin as antibiotic prophylaxis, 2,15 and the MIC breakpoint of this pathogen is 4 mg/L based on free concentration 16–19 . When considering f u , the target total concentration can be determined as ( C total = C free / f u ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The expected advantage of administering prophylactic antibiotics using target‐ concentration controlled infusion: Development of a new pharmacokinetic model of cefazolin

Kim

Lee

Yang

et al. 2022

Clin Exp Pharma Physio

View full text Add to dashboard Cite

The aim of this study was to explore the utility of target-concentration controlled infusion (TCI) as a prophylactic antibiotic administration method based on the results of a population pharmacokinetic model of cefazolin. In patients undergoing elective gastric surgery, 2 g of cefazolin was dissolved in 50 mL of saline and administered for 10 min prior to skin incision. Arterial blood samples were obtained at preset intervals

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The expected advantage of administering prophylactic antibiotics using target‐ concentration controlled infusion: Development of a new pharmacokinetic model of cefazolin

Kim

Lee

Yang

et al. 2022

Clin Exp Pharma Physio

View full text Add to dashboard Cite

show abstract

“…Among surgeries using cefazolin as a prophylactic antibiotic, the predominant causative organism of SSIs is Staphylococcus aureus . To prevent SSIs, the tissue concentration of antibiotics is important, and in a previous study, the minimum tissue inhibitory concentration of cefazolin was 4 μg g −1 12 . Considering that the AUC subcutaneous fatty tissue /AUC unbound plasma in a previous study was about 0.4, 12 the target unbound concentration could be set at 10 μg mL −1 .…”

Section: Methodsmentioning

confidence: 99%

“…To prevent SSIs, the tissue concentration of antibiotics is important, and in a previous study, the minimum tissue inhibitory concentration of cefazolin was 4 μg g À1 . 12 Considering that the AUC subcutaneous fatty tissue /AUC unbound plasma in a previous study was about 0.4, 12 the target unbound concentration could be set at 10 μg mL À1 . Since the average fu observed in previous cefazolin pharmacokinetic modelling studies was 0.18, the target total concentration reflecting this is about 56 μg mL À1 .…”

Section: Study Proceduresmentioning

confidence: 99%

External validation of a pharmacokinetic model for target‐controlled infusion of cefazolin as a prophylactic antibiotic

Lee,

Yoon,

Park

et al. 2023

Brit J Clinical Pharma

View full text Add to dashboard Cite

AimsThis study aimed to evaluate the predictive performance of previously constructed cefazolin pharmacokinetic models and determine whether cefazolin administration via the target‐controlled infusion (TCI) method may be possible in clinical practice.MethodsTwenty‐five gastrectomy patients receiving cefazolin as a prophylactic antibiotic were enrolled. Two grams of cefazolin were dissolved in 50 mL of normal saline to give a concentration of 40 mg mL‐1. Before skin incision, cefazolin was administered using a TCI syringe pump and its administration continued until the end of surgery. The target total plasma concentration was set to 100 μg mL‐1. Total and unbound plasma concentrations of cefazolin were measured in three arterial blood samples collected at 30, 60, and 120 min after the start of cefazolin administration. The predictive performance of the TCI system was evaluated using four measures: inaccuracy, divergence, bias, and wobble.ResultsTotal (n = 75) and unbound (n = 75) plasma concentration measurements from 25 patients were included in the analysis. The pooled median (95% confidence interval) biases and inaccuracies were 6.3 (4.0 to 8.5) and 10.5 (8.6 to 12.4) for the total concentration model, and ‐10.3 (‐16.8 to ‐3.7) and 22.4 (18.2 to 26.7) for the unbound concentration model, respectively. All unbound concentrations were above 10 μg mL‐1.ConclusionAdministration of cefazolin by the TCI method showed a clinically acceptable performance. Applying the TCI method by setting the total concentration as the target concentration rather than the unbound concentration is effective in maintaining a constant target concentration of cefazolin.

show abstract

“…A BMI of Ͼ50 kg/m 2 was significantly associated with an increased probability of not reaching the PK/PD target for S. aureus. Previous studies concerning ␤-lactam (mostly cefazolin) PK/PD for AP in which BMIs were compared observed significant differences in plasma and/or tissue free concentrations of antibiotics (15)(16)(17). Concerning cefoxitin, BMI as a factor of underdosage was never specifically explored in these studies (6,7).…”

Section: Figmentioning

confidence: 98%

Observational, Prospective Single-Center Study of Antibiotic Prophylaxis with High-Dose Cefoxitin in Bariatric Surgery

Belveyre

Guerci

Pape

et al. 2019

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The optimal dose of cefoxitin for antibiotic prophylaxis in obese patients remains uncertain. We evaluated the adequacy of a 4-g dosing regimen of cefoxitin against the most common pathogens that infect patients undergoing bariatric surgery. This observational prospective study included obese patients who required bariatric surgery and a 4-g dose of cefoxitin as an antibiotic prophylaxis. Serum concentrations were measured during surgery (incision, wound closure, and in case of reinjection). The pharmacokinetic/pharmacodynamic (PK/PD) target was to obtain free cefoxitin concentrations above 4× MIC, from incision to wound closure (100% fT>4×MIC). The targeted MIC was based on the worst-case scenario (the highest ECOFF value of Staphylococcus aureus, Enterobacteriaceae, and anaerobic bacteria). The secondary outcomes were the factors related to underdosage. A total of 200 patients were included. The mean age of the patients was 46 ± 12 years old, and the mean body mass index (BMI) was 45.8 ± 6.9 kg/m2. Bypass surgery was the preferred technique (84%). The percentages of patients who met the PK/PD target (100% fT>4×MIC) of cefoxitin were 37.3, 1.1, and 0% for S. aureus, Enterobacteriaceae and anaerobic bacteria, respectively. BMIs below 50 kg/m2 (odds ratio [OR] = 0.29, 95% confidence interval [CI] = 0.11 to 0.75, P = 0.0107) and a shorter duration of surgery (OR = 0.97, 95% CI = 0.95 to 0.99, P = 0.004) were associated with reaching the target concentrations. In obese patients undergoing bariatric surgery, a regimen of 4 g of cefoxitin led to an inadequate coverage for most common pathogens. A longer surgery duration and a BMI of >50 kg/m2 increase the risk of underdosage. (This study was registered on ClinicalTrials.gov under identifier NCT03306290.)

show abstract

Cefazolin tissue concentrations with a prophylactic dose administered before sleeve gastrectomy in obese patients: a single centre study in 116 patients

Abstract: NCT01537380.

Cited by 12 publications

References 28 publications

The expected advantage of administering prophylactic antibiotics using target‐ concentration controlled infusion: Development of a new pharmacokinetic model of cefazolin

The expected advantage of administering prophylactic antibiotics using target‐ concentration controlled infusion: Development of a new pharmacokinetic model of cefazolin

External validation of a pharmacokinetic model for target‐controlled infusion of cefazolin as a prophylactic antibiotic

Observational, Prospective Single-Center Study of Antibiotic Prophylaxis with High-Dose Cefoxitin in Bariatric Surgery

Contact Info

Product

Resources

About