Effect of surgical blood loss and volume replacement on antibiotic pharmacokinetics

Sue, Doris; Salazar, Theresa A.; Turley, Kevin; Guglielmo, B. Joseph

doi:10.1016/0003-4975(89)90020-9

Cited by 16 publications

(7 citation statements)

References 8 publications

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“…Swoboda et al 24 studied the effect of intraoperative blood loss on the serum and tissue concentrations of cefazolin in spinal instrumentation surgical procedures and concluded that the effect of the antibiotic diminished and an additional dose was necessary when the blood loss exceeded 1500 mL. On the other hand, Sue et al 25 reported that the blood loss in cardiac surgery had minimal effect on the elimination of cefazolin; 14% of the cefazolin dose administered was lost as a result of intraoperative bleeding, despite the mean blood loss being 110 mL/h and total blood loss being over a liter, with crystalloid replacement in excess of 3 L. Nevertheless, surgeons should note that minimization of intraoperative blood loss is important to reduce the risk of development of SSIs after elective gastric cancer surgery. Advanced age has also been reported to be a risk factor for the development of SSIs after gastric surgery, 15,26 although the exact reasons are unclear and further investigation is warranted.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery

Haga

Ishida

Ishiguro

et al. 2012

International Surgery

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The duration of antimicrobial prophylaxis in gastric cancer surgery is not yet established. This prospective randomized study was performed to confirm the noninferiority of single-dose versus multiple-dose antimicrobial prophylaxis in terms of the incidence of surgical-site infection in gastric cancer surgery. Three hundred twenty-five patients undergoing elective resection for gastric cancer were randomized to receive only singledose cefazolin (1 g) during surgery (single-dose group) or an additional 5 doses every 12 hours postoperatively (multiple-dose group). The overall incidence of surgical-site infections was 9.1% in the single-dose group and 6.2% in the multiple-dose group [difference (95% confidence interval): 22.9% (25.9%-0.0%)]. Multivariate logistic regression analysis identified blood loss, being overweight, and advanced age as significant independent risk factors for surgical-site infection. Single-dose antimicrobial prophylaxis seemed to be acceptable, and choosing multiple-dose prophylaxis may have little impact on the prevention of surgical-site infections in elective gastric cancer surgery.

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Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery

Haga

Ishida

Ishiguro

et al. 2012

International Surgery

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“…Greater blood loss might have an effect on the risk of surgical‐site infection if the antibiotic is lost from the circulation as a result of bleeding. Antibiotic pharmacokinetics in patients having cardiac surgery17 showed that only 14 per cent of the cefazolin dose administered was lost as a result of intraoperative bleeding despite mean blood losses of 110 ml/h, with a total blood loss of over a litre and crystalloid replacement in excess of 3 litres. It seems unlikely that differences in blood loss have affected outcomes in the present study.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of single- versus multiple-dose antimicrobial prophylaxis in gastric cancer surgery

Mohri

Tonouchi

Kobayashi

et al. 2007

British Journal of Surgery

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“…These results are surprising, since lowered antibiotic levels have been found in other patients who underwent lengthy operations with extensive blood loss (20). Substantial distribution of cefotaxime and ampicillin into extravascular fluids and tissues that act as reservoirs from which the antibiotics can reenter the circulation probably is an important factor contributing to the "normal" levels in serum in the liver transplant patients we studied (35). Also, the impaired hepatic and renal functions of our patients probably increased the elimination half-lives of cefotaxime and ampicillin intraoperatively (15,22,41), partially compensating for antibiotic loss caused by bleeding.…”

Section: Discussionmentioning

confidence: 88%

Microbiological efficacy and pharmacokinetics of prophylactic antibiotics in liver transplant patients

Arnow

Furmaga

Flaherty

et al. 1992

Antimicrob Agents Chemother

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The pharmacokinetics of perioperative systemic antibiotics and the microbiological effectiveness of oral nonabsorbable antibiotics started immediately prior to surgery were studied in 18 adult patients undergoing liver transplantation. All patients received cefotaxime, 2 g intravenously, at 6-h intervals during surgery and then at 8-h intervals thereafter for 48 h; eight patients also received ampicillin at the same dose and schedule. This regimen produced levels of antibiotics in blood that appeared appropriate for prophylaxis. The first dose peak (68 ± 18 ,ig/ml) and trough (6.9 + 4.7 ,g/ml) levels of cefotaxime in serum and the first dose peak (73 ± 22 ,ug/ml) and trough (4.1 + 2.3 ,ug/ml) levels of ampicillin in serum, which were assayed by high-performance liquid chromatography, were similar to levels reported in normal volunteers, despite mean intraoperative blood loss of 3.3 liters and fluid replacement of 21 liters. On postoperative days 1 and 2, the levels of cefotaxime and ampicillin were maintained at or above 0.9 and 1.3 pg/ml, respectively, with little accumulation. By random assignment, 8 patients received systemic antibiotics alone and 10 patients received systemic antibiotics plus a 3-week regimen of oral nonabsorbable antibiotics (gentamicin, polymyxin E, and nystatin) beginning when a donor liver was procured. Pre-and postoperative cultures of rectum, throat, and gastric aspirate samples showed persistence of aerobic gram-negative bacilli for the first 2 postoperative weeks in about half of the patients in each group. Failure of the regimen of oral nonabsorbable antibiotics to supplement cefotaxime in eradicating aerobic gram-negative bacilli from stools probably results from impaired peristalsis during and after surgery and warrants earlier initiation of the regimen.Bacterial and fungal infections frequently complicate orthotopic liver transplantation (OLT), despite routine perioperative prophylaxis with broad-spectrum antibiotics and sometimes antifungal agents. Most liver transplant patients experience at least one serious bacterial infection (11, 16), and the incidence of fungal infection has ranged from 16 to 42% (4,6,17,38). The characteristics of posttransplant bacterial and fungal infections are that most occur during the first few weeks after transplantation; the predominant pathogens in each category are aerobic gram-negative bacilli (AGNB) and Candida albicans; and the most common sites of infection are the abdomen, lower respiratory tract, and bloodstream (4,6,11,16,17,38). These features suggest that posttransplant infections usually result from perioperative inoculation or translocation of potentially pathogenic bowel flora into the abdomen and bloodstream or from aspiration of oropharyngeal AGNB.In an effort to reduce the incidence of posttransplant infection beyond that achieved with systemic antibiotic prophylaxis, several centers have supplemented systemic antibiotics with regimens of topical oropharyngeal and oral nonabsorbable antimicrobial agents to selectively eliminate AG...

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Effect of surgical blood loss and volume replacement on antibiotic pharmacokinetics

Cited by 16 publications

References 8 publications

A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery

A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery

Randomized clinical trial of single- versus multiple-dose antimicrobial prophylaxis in gastric cancer surgery

Microbiological efficacy and pharmacokinetics of prophylactic antibiotics in liver transplant patients

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