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Observational Study
. 2021 Apr-Jun;24(2):149-154.
doi: 10.4103/aca.ACA_106_19.

Plasma concentrations of cefazolin in pediatric patients undergoing cardiac surgery

Saowaphak Lapmahapaisan  1 , Wiriya Maisat  1 , Kriangkrai Tantiwongkosri  2 , Pinpilai Jutasompakorn  3 , Waraphorn Sisan  3
Affiliations
Observational Study

Plasma concentrations of cefazolin in pediatric patients undergoing cardiac surgery

Saowaphak Lapmahapaisan et al. Ann Card Anaesth. 2021 Apr-Jun.

Abstract

Background: The guideline for antibiotic prophylaxis in pediatric cardiac surgery is currently unavailable, and the effects of cardiopulmonary bypass (CPB) may result in low plasma cefazolin concentrations and subsequent postoperative surgical site infections (SSIs).

Aims: To demonstrate the calculated-unbound plasma concentrations of cefazolin during uncomplicated pediatric cardiac surgery.

Settings and design: A prospective observational study that included 18 patients <seven years of age, undergoing elective cardiac surgery with CPB.

Materials and methods: An intravenous infusion of cefazolin (25 mg.kg-1) was administered to patients over 30 minutes within 1 hour before skin incision (first dose). Another 25 mg.kg-1 infusion was administered to the CPB prime volume (second dose). Blood samples were obtained at eight time points: 15 minutes after the first dose (T1); before aortic cannulation (T2); immediately after CPB initiation (T3); 30 (T4), 60 (T5), and 120 (T6) minutes after CPB; 15 minutes after CPB discontinuation (T7), and at skin closure (T8). The total plasma cefazolin concentrations were measured using liquid chromatography tandem mass spectrometry.

Results: The unbound cefazolin concentrations were calculated assuming 80%-protein binding. The median cefazolin levels were 18.1 (range 4.3-27.0), 11.9 (2.8-24.1), 31.4 (18.3-66.1), 23.4 (13.7-35.9), 20.2 (15.4-24.9), 17.7 (14.8-18.0), 15.6 (9.8-26.2), and 13.3 (8.3-24.6) μg.mL-1 from T1-T8, respectively. The cefazolin levels remained four times above the minimum inhibitory concentrations (MICs) for Methicillin-sensitive S. aureus (MSSA) and S. epidermidis in most patients, but they were inadequate for Enterobacter and E. coli.

Conclusion: This regimen produced adequate plasma cefazolin concentrations for common organisms that cause SSIs after cardiac surgery.

Keywords: Cardiac surgery; cardiopulmonary bypass; cefazolin; pediatric; surgical site infection.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Timing of cefazolin administrations and blood collections
Figure 2
Figure 2
Predicted unbound plasma concentrations, based on measured total and 0.8 fraction bound at different time points. Dashed lines represent target concentrations of 4, 8, and 16 μg.mL-1
See this image and copyright information in PMC

Comment in

References

    1. Alphonso N, Anagnostopoulos PV, Scarpace S, Weintrub P, Azakie A, Raff G, et al. Perioperative antibiotic prophylaxis in paediatric cardiac surgery. Cardiol Young. 2007;17:12–25. - PubMed
    1. Lepelletier D, Perron S, Bizouarn P, Caillon J, Drugeon H, Michaud JL, et al. Surgical-site infection after cardiac surgery: Incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol. 2005;26:466–72. - PubMed
    1. Paul M, Raz A, Leibovici L, Madar H, Holinger R, Rubinovitch B. Sternal wound infection after coronary artery bypass graft surgery: Validation of existing risk scores. J Thorac Cardiovasc Surg. 2007;133:397–403. - PubMed
    1. Beckmann A, Doebler K, Schaefer E, Koetting J, Gastmeier P, Graf K. Sternal surgical site infection prevention–Is there any room for improvement? Eur J Cardiothorac Surg. 2011;40:347–51. - PubMed
    1. Bratzler DW, Houck PM. Surgical Infection Prevention Guideline Writers W. Antimicrobial prophylaxis for surgery: An advisory statement from the National surgical infection prevention project. Am J Surg. 2005;189:395–404. - PubMed

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