End-of-procedure cefazolin concentrations after administration for prevention of surgical-site infection

Erin Koopman, David E. Nix, Brian L Erstad, Michael J. Demeure, Melinda M. Hayes, John T Ruth, Kathryn R Matthias

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose. The adequacy of end-of-procedure free cefazolin concentrations after administration for the prevention of surgical-site infection (SSI) and compliance with national guidelines for antimicrobial prophylaxis for SSI were assessed. Methods. Patients undergoing elective surgery and receiving cefazolin for perioperative antimicrobial prophylaxis were prospectively enrolled. Antibiotic administration was controlled by the surgeon and usage was recorded. For each patient, a single blood sample for cefazolin serum free and total concentrations was obtained within 15 minutes of wound closure. A free serum concentration threshold of 4 μg/mL was arbitrarily chosen based on the minimum inhibitory concentration required to inhibit 90% of strains of methicillin-susceptible Staphylococcus aureus and Escherichia coli. Results. Fifty-seven subjects were enrolled, and noncompliance with published guidelines was observed for 26% of patients. Forty-six subjects had serum samples available for assay, 21.7% of whom had end-of-procedure free cefazolin concentrations of <4 μg/mL. Results of multivariate regression and population pharmacokinetic analysis revealed the importance of age and lean body weight in cefazolin clearance. Younger and taller patients had a greater risk of achieving below-threshold end-of-procedure concentrations. Of the patients for whom published guidelines were not followed, 67% had end-of-procedure free cefazolin concentrations below the threshold concentration (4 μg/mL). In contrast, less than 15% of cases where SSI prophylaxis complied with the published guidelines had below-threshold concentrations at the end of surgery. Conclusion. Noncompliance with antimicrobial prophylaxis guidelines was associated with low end-of-procedure antibiotic levels. Compliance with guidelines did not guarantee adequate levels.

Original languageEnglish (US)
Pages (from-to)1927-1934
Number of pages8
JournalAmerican Journal of Health-System Pharmacy
Volume64
Issue number18
DOIs
StatePublished - Sep 15 2007

Fingerprint

Surgical Wound Infection
Cefazolin
Guidelines
Serum
Anti-Bacterial Agents
Methicillin
Microbial Sensitivity Tests
Staphylococcus aureus
Pharmacokinetics
Body Weight
Escherichia coli
Wounds and Injuries
Population

Keywords

  • Age
  • Bacterial infections
  • Blood levels
  • Cefazolin
  • Cephalosporins
  • Compliance
  • Excretion
  • Minimum inhibitory concentration
  • Pharmacokinetics
  • Protocols
  • Surgery
  • Weight

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Leadership and Management
  • Medicine(all)

Cite this

End-of-procedure cefazolin concentrations after administration for prevention of surgical-site infection. / Koopman, Erin; Nix, David E.; Erstad, Brian L; Demeure, Michael J.; Hayes, Melinda M.; Ruth, John T; Matthias, Kathryn R.

In: American Journal of Health-System Pharmacy, Vol. 64, No. 18, 15.09.2007, p. 1927-1934.

Research output: Contribution to journalArticle

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abstract = "Purpose. The adequacy of end-of-procedure free cefazolin concentrations after administration for the prevention of surgical-site infection (SSI) and compliance with national guidelines for antimicrobial prophylaxis for SSI were assessed. Methods. Patients undergoing elective surgery and receiving cefazolin for perioperative antimicrobial prophylaxis were prospectively enrolled. Antibiotic administration was controlled by the surgeon and usage was recorded. For each patient, a single blood sample for cefazolin serum free and total concentrations was obtained within 15 minutes of wound closure. A free serum concentration threshold of 4 μg/mL was arbitrarily chosen based on the minimum inhibitory concentration required to inhibit 90{\%} of strains of methicillin-susceptible Staphylococcus aureus and Escherichia coli. Results. Fifty-seven subjects were enrolled, and noncompliance with published guidelines was observed for 26{\%} of patients. Forty-six subjects had serum samples available for assay, 21.7{\%} of whom had end-of-procedure free cefazolin concentrations of <4 μg/mL. Results of multivariate regression and population pharmacokinetic analysis revealed the importance of age and lean body weight in cefazolin clearance. Younger and taller patients had a greater risk of achieving below-threshold end-of-procedure concentrations. Of the patients for whom published guidelines were not followed, 67{\%} had end-of-procedure free cefazolin concentrations below the threshold concentration (4 μg/mL). In contrast, less than 15{\%} of cases where SSI prophylaxis complied with the published guidelines had below-threshold concentrations at the end of surgery. Conclusion. Noncompliance with antimicrobial prophylaxis guidelines was associated with low end-of-procedure antibiotic levels. Compliance with guidelines did not guarantee adequate levels.",
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N2 - Purpose. The adequacy of end-of-procedure free cefazolin concentrations after administration for the prevention of surgical-site infection (SSI) and compliance with national guidelines for antimicrobial prophylaxis for SSI were assessed. Methods. Patients undergoing elective surgery and receiving cefazolin for perioperative antimicrobial prophylaxis were prospectively enrolled. Antibiotic administration was controlled by the surgeon and usage was recorded. For each patient, a single blood sample for cefazolin serum free and total concentrations was obtained within 15 minutes of wound closure. A free serum concentration threshold of 4 μg/mL was arbitrarily chosen based on the minimum inhibitory concentration required to inhibit 90% of strains of methicillin-susceptible Staphylococcus aureus and Escherichia coli. Results. Fifty-seven subjects were enrolled, and noncompliance with published guidelines was observed for 26% of patients. Forty-six subjects had serum samples available for assay, 21.7% of whom had end-of-procedure free cefazolin concentrations of <4 μg/mL. Results of multivariate regression and population pharmacokinetic analysis revealed the importance of age and lean body weight in cefazolin clearance. Younger and taller patients had a greater risk of achieving below-threshold end-of-procedure concentrations. Of the patients for whom published guidelines were not followed, 67% had end-of-procedure free cefazolin concentrations below the threshold concentration (4 μg/mL). In contrast, less than 15% of cases where SSI prophylaxis complied with the published guidelines had below-threshold concentrations at the end of surgery. Conclusion. Noncompliance with antimicrobial prophylaxis guidelines was associated with low end-of-procedure antibiotic levels. Compliance with guidelines did not guarantee adequate levels.

AB - Purpose. The adequacy of end-of-procedure free cefazolin concentrations after administration for the prevention of surgical-site infection (SSI) and compliance with national guidelines for antimicrobial prophylaxis for SSI were assessed. Methods. Patients undergoing elective surgery and receiving cefazolin for perioperative antimicrobial prophylaxis were prospectively enrolled. Antibiotic administration was controlled by the surgeon and usage was recorded. For each patient, a single blood sample for cefazolin serum free and total concentrations was obtained within 15 minutes of wound closure. A free serum concentration threshold of 4 μg/mL was arbitrarily chosen based on the minimum inhibitory concentration required to inhibit 90% of strains of methicillin-susceptible Staphylococcus aureus and Escherichia coli. Results. Fifty-seven subjects were enrolled, and noncompliance with published guidelines was observed for 26% of patients. Forty-six subjects had serum samples available for assay, 21.7% of whom had end-of-procedure free cefazolin concentrations of <4 μg/mL. Results of multivariate regression and population pharmacokinetic analysis revealed the importance of age and lean body weight in cefazolin clearance. Younger and taller patients had a greater risk of achieving below-threshold end-of-procedure concentrations. Of the patients for whom published guidelines were not followed, 67% had end-of-procedure free cefazolin concentrations below the threshold concentration (4 μg/mL). In contrast, less than 15% of cases where SSI prophylaxis complied with the published guidelines had below-threshold concentrations at the end of surgery. Conclusion. Noncompliance with antimicrobial prophylaxis guidelines was associated with low end-of-procedure antibiotic levels. Compliance with guidelines did not guarantee adequate levels.

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