Perioperative antibiotic prophylaxis in the gastric bypass patient: Do we achieve therapeutic levels?

Charles E. Edmiston, Candace Krepel, Holly Kelly, Jeffery Larson, Deborah Andris, Cindy Hennen, Attila Nakeeb, James R. Wallace

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Perioperative surgical antibiotic prophylaxis requires that therapeutically effective drug concentrations be present in the tissues. Patients undergoing Roux-en-Y gastric bypass for morbid obesity were given 2 g cefazolin preoperatively, followed by a second dose at 3 hours. Thirty-eight patients were each assigned to 1 of 3 body mass index (BMI) groups: (A) BMI = 40-49 (N = 17); (B) BMI = 50-59 (N = 11); (C) BMI ≥ 60 (N = 10). Multiple timed serum (baseline; incision, 15, 30, 60 minutes; prior to second prophylactic dose; and closure) and tissue (skin, subcutaneous fat, and omentum) specimens were collected and cefazolin concentration analyzed by microbiological assay. No significant difference was observed in intraoperative fluid replacement or blood loss among BMI groups. Serum antimicrobial concentrations exceeded resistance breakpoint (32 μg/mL) in 73%, 68%, and 52% of BMI groups A, B, and C, respectively. No significant difference in cefazolin concentration was observed in mean incisional skin and closure tissue specimens in groups A, B, and C. A significant decrease in cefazolin concentration was noted in closure adipose (p =. 04), initial (p =. 03) and closure omentum (p =. 05) tissues in groups B and C compared with A. Over 90% of serum samples exhibited therapeutic concentrations covering 53.8% of gram-positive and 78.6% of gram-negative surgical pathogens. However, therapeutic tissue levels were achieved in only 48.1%, 28.6%, and 10.2% of groups A, B, and C, respectively. Pharmacokinetic analysis suggests that present dosing strategies may fail to provide adequate perioperative prophylaxis in gastric bypass patients.

Original languageEnglish (US)
Pages (from-to)738-747
Number of pages10
JournalSurgery
Volume136
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

Fingerprint

Gastric Bypass
Antibiotic Prophylaxis
Cefazolin
Body Mass Index
Omentum
Therapeutics
Serum
Skin
Morbid Obesity
Subcutaneous Fat
Pharmacokinetics
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Surgery

Cite this

Edmiston, C. E., Krepel, C., Kelly, H., Larson, J., Andris, D., Hennen, C., ... Wallace, J. R. (2004). Perioperative antibiotic prophylaxis in the gastric bypass patient: Do we achieve therapeutic levels? Surgery, 136(4), 738-747. https://doi.org/10.1016/j.surg.2004.06.022

Perioperative antibiotic prophylaxis in the gastric bypass patient : Do we achieve therapeutic levels? / Edmiston, Charles E.; Krepel, Candace; Kelly, Holly; Larson, Jeffery; Andris, Deborah; Hennen, Cindy; Nakeeb, Attila; Wallace, James R.

In: Surgery, Vol. 136, No. 4, 10.2004, p. 738-747.

Research output: Contribution to journalArticle

Edmiston, CE, Krepel, C, Kelly, H, Larson, J, Andris, D, Hennen, C, Nakeeb, A & Wallace, JR 2004, 'Perioperative antibiotic prophylaxis in the gastric bypass patient: Do we achieve therapeutic levels?', Surgery, vol. 136, no. 4, pp. 738-747. https://doi.org/10.1016/j.surg.2004.06.022
Edmiston, Charles E. ; Krepel, Candace ; Kelly, Holly ; Larson, Jeffery ; Andris, Deborah ; Hennen, Cindy ; Nakeeb, Attila ; Wallace, James R. / Perioperative antibiotic prophylaxis in the gastric bypass patient : Do we achieve therapeutic levels?. In: Surgery. 2004 ; Vol. 136, No. 4. pp. 738-747.
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abstract = "Perioperative surgical antibiotic prophylaxis requires that therapeutically effective drug concentrations be present in the tissues. Patients undergoing Roux-en-Y gastric bypass for morbid obesity were given 2 g cefazolin preoperatively, followed by a second dose at 3 hours. Thirty-eight patients were each assigned to 1 of 3 body mass index (BMI) groups: (A) BMI = 40-49 (N = 17); (B) BMI = 50-59 (N = 11); (C) BMI ≥ 60 (N = 10). Multiple timed serum (baseline; incision, 15, 30, 60 minutes; prior to second prophylactic dose; and closure) and tissue (skin, subcutaneous fat, and omentum) specimens were collected and cefazolin concentration analyzed by microbiological assay. No significant difference was observed in intraoperative fluid replacement or blood loss among BMI groups. Serum antimicrobial concentrations exceeded resistance breakpoint (32 μg/mL) in 73{\%}, 68{\%}, and 52{\%} of BMI groups A, B, and C, respectively. No significant difference in cefazolin concentration was observed in mean incisional skin and closure tissue specimens in groups A, B, and C. A significant decrease in cefazolin concentration was noted in closure adipose (p =. 04), initial (p =. 03) and closure omentum (p =. 05) tissues in groups B and C compared with A. Over 90{\%} of serum samples exhibited therapeutic concentrations covering 53.8{\%} of gram-positive and 78.6{\%} of gram-negative surgical pathogens. However, therapeutic tissue levels were achieved in only 48.1{\%}, 28.6{\%}, and 10.2{\%} of groups A, B, and C, respectively. Pharmacokinetic analysis suggests that present dosing strategies may fail to provide adequate perioperative prophylaxis in gastric bypass patients.",
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