Cephalothin prophylaxis in cardiac valve surgery

Goldmann, Donald A.; Hopkins, Cyrus C.; Karchmer, Adolf W.; Abel, Ronald M.; McEnany, M. Terry; Akins, Cary W.; Buckley, Mortimer J.; Moellering, Robert C.; Noel, Barbara

doi:10.1016/s0022-5223(19)39932-5

Cited by 162 publications

(12 citation statements)

References 36 publications

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“…The benefit extended beyond this threshold in our study, a finding that may reflect the markedly prolonged serum half-life of cefazolin during cardiopulmonary bypass. Although the half-life of cefazolin is 1.8 h in healthy persons (3), several studies have shown a slower elimination during cardiopulmonary bypass (14,16,17). Therefore, any benefit of redosing in noncardiac surgery may be observed for shorter procedures than in cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Zanetti

Giardina

Platt

2001

Emerg. Infect. Dis.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Zanetti

Giardina

Platt

2001

Emerg. Infect. Dis.

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“…An earlier guideline by the ASHP recommended intraoperative redosing after 2 half-lives of the administered agent have passed since initial SAP administration. This recommendation was based on pharmacokinetic principles and evidence that adequate tissue- and plasma concentrations of antibiotics are necessary throughout the surgical procedure to prevent surgical site infection 11–13 . The present systematic review and meta-analysis provides clinical evidence to this context.…”

Section: Discussionmentioning

confidence: 97%

“…[7][8][9] Evidence of the effect of timely preoperative administration of SAP suggest that adequate tissue concentration is needed at the time of incision and throughout the procedure for SAP to be effective. [10][11][12] Similarly, inadequate antibiotic tissue concentration upon wound closure is associated with increased risk of SSI 13 and the redundancy of postoperative continuation of antibiotics depends on timely preoperatively administration and intraoperative redosing. 14 Tissue concentration depends on pharmacokinetics, pharmacodynamics, the initial dose, and the time passed since the initial dose.…”

mentioning

confidence: 99%

Intraoperative Redosing of Surgical Antibiotic Prophylaxis in Addition to Preoperative Prophylaxis Versus Single-dose Prophylaxis for the Prevention of Surgical Site Infection

et al. 2022

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The aim of this study was to determine the effect of preoperative surgical antibiotic prophylaxis (SAP) with additional intraoperative redosing compared to single-dose preoperative surgical antibiotic prophylaxis on the incidence of surgical site infections (SSI). Summary Background Data: Preoperative SAP is standard care for the prevention of SSI. During long surgical procedures, additional intraoperative redosing of SAP is advised, but there is great variability in redosing strategies and compliance rates. Methods: We performed a systematic search of MEDLINE (PubMed), Embase, CINAHL and CENTRAL on June 25 th , 2021 according to PROS-PERO registration CRD42021229035. We included studies that compared the effect of preoperative SAP with additional intraoperative redosing to single dose preoperative SAP (no redosing) on SSI incidence in patients undergoing any type of surgery. Two researchers performed data appraisal and extraction of summary data independently. Meta-analyses were stratified per study type. We used a generic inverse variance random-effects model to estimate a pooled odds ratio with corresponding 95% confidence intervals (CIs).Results: We included 2 randomized controlled trials (RCT) and 8 cohort studies comprising of 9470 patients. Pooled odds ratios for SSI in patients receiving intraoperative redosing compared to those without redosing were 0.47 (95% CI: 0.19-1.16. I 2 ¼ 36%) for RCTs and 0.55 (95% CI: 0.38-0.79, I 2 ¼ 56%) for observational cohorts. There was considerable clinical heterogeneity among antibiotics used and redosing protocols. GRADE-assessment showed overall low certainty of evidence. Conclusion: Intraoperative redosing of SAP may reduce incidence of SSI compared to a single dose preoperative SAP in any type of surgery, based on studies with considerable heterogeneity of antibiotic regimens and redosing protocols.

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“…Older studies have demonstrated lower rates of infection in patients with detectable antibiotics in the serum at the end of the operation compared with in patients in whom the concentrations of antibiotics are below the MIC of commonly infecting organisms. 27,28…”

Section: Timing and Dosementioning

confidence: 99%

Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology

Azamgarhi,

Warren,

Fouch

et al. 2023

Bone Joint J

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The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic prophylaxis from 24 hours to five days after endoprosthetic reconstruction for lower limb bone tumours. PARITY is the first randomized controlled trial in orthopaedic oncology and is a huge step forward in understanding antibiotic prophylaxis. However, significant gaps remain, including questions around antibiotic choice, particularly in the UK, where cephalosporins are avoided due to concerns of Clostridioides difficile infection. We present a review of the evidence for antibiotic choice, dosing, and timing, and a brief description of PARITY, its implication for practice, and the remaining gaps in our understanding.Cite this article: Bone Joint J 2023;105-B(8):850–856.

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Cephalothin prophylaxis in cardiac valve surgery

Cited by 162 publications

References 36 publications

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Intraoperative Redosing of Surgical Antibiotic Prophylaxis in Addition to Preoperative Prophylaxis Versus Single-dose Prophylaxis for the Prevention of Surgical Site Infection

Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology

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