1
|
Takayama Y, Komatsu T, Nakamura T, Tomoda Y, Toda M, Miura H, Sato T, Atsuda K, Okamoto H, Hanaki H. Association of serum and fat tissue antibiotic concentrations with surgical site infections in lower gastrointestinal surgery. Surgery 2022; 171:1000-1005. [PMID: 34772516 DOI: 10.1016/j.surg.2021.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND During surgery, the effectiveness of perioperative prophylactic antibiotic administration against surgical site infections is inferred from serum concentrations and not from tissues where local infections occur. This study aimed to measure the serum and tissue concentrations of cefmetazole in colorectal surgery cases to clarify whether there is an association between the incidence of surgical site infections and antibiotic concentrations. METHODS This prospective cohort study was performed at a single tertiary care center. The data of 105 patients who underwent colorectal surgery between October 2017 and September 2019 were evaluated. The primary outcome was the incidence of surgical site infections. Univariate analysis was performed to investigate the association between surgical site infections, perioperative factors, and the serum and tissue concentrations of cefmetazole. RESULTS The incidence of surgical site infections was 13/105 (12.4%). Cefmetazole concentrations were measured at initial incision (serum; 101 vs 93.1 mg/L, P = .75, subcutaneous fat tissue; 2.8 vs 3.7 mg/g, P = .15), intestinal resection (serum; 35.1 vs 36.7 mg/L, P = .63, mesenteric adipose tissue; 1.3 vs 1.7 mg/g, P = .55), and at skin closure (serum; 34.5 vs 44.8 mg/L, P = .18, subcutaneous fat tissue; 1.0 vs 2.2 mg/g, P = .09). In univariate analysis with P ≤ .10, cefmetazole concentration in subcutaneous fat tissue at skin closure was found to be a significant risk factor for surgical site infections. Age, additional intraoperative administration of cefmetazole, and creatinine clearance were also significant risk factors for the occurrence of surgical site infections. CONCLUSION Low subcutaneous fat cefmetazole concentrations at skin closure during gastrointestinal operations may also be involved in the occurrence of surgical site infections.
Collapse
Affiliation(s)
- Yoko Takayama
- Department of Infection Control and Infectious Diseases, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan; Department of Infection Control and Prevention, Kitasato University Hospital, Kanagawa, Japan.
| | - Toshiaki Komatsu
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | | | - Yoshinori Tomoda
- Laboratory of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Kanagawa, Japan
| | - Masaya Toda
- Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hirohisa Miura
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takeo Sato
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichiro Atsuda
- Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Tokyo, Japan
| | - Hirotsugu Okamoto
- Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hideaki Hanaki
- Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| |
Collapse
|
2
|
Belveyre T, Scala-Bertola J, Esposito M, Luc A, Lipman J, Novy E. Influence of the Obesity Phenotype on the Adequacy of Antibiotic Prophylaxis with Cefoxitin for Obese Patients Undergoing Bariatric Surgery: Lessons Learnt and Future Considerations. Eur J Drug Metab Pharmacokinet 2021; 46:479-485. [PMID: 33959888 DOI: 10.1007/s13318-021-00688-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES A high inter-individual variability in pharmacokinetic parameters in obese patients is observed. The objective of this study was to evaluate the effect of obesity parameters on the pharmacokinetics of cefoxitin administered for antibiotic prophylaxis during bariatric surgery. METHODS This a secondary analysis of a pharmacokinetic study involving 174 obese patients scheduled for bariatric surgery and receiving a 4-g dose of cefoxitin. Blood samples were collected at incision and wound closure. The total plasma concentrations were assessed utilising a validated high-performance liquid chromatography-tandem mass spectrometry method. The pharmacokinetic and pharmacodynamic target was defined as an estimated free concentration of cefoxitin at the time of wound closure >8 mg/L. Specific evaluated obesity parameters were fat body mass, fat body mass/height2, lean body mass, lean body mass/height2, visceral adipose tissue and presence of a metabolic syndrome. RESULTS A total of 174 patients (median age 47 years) with a majority of women (75.3%) and a median BMI of 44 kg/m2 were analysed. The percentage of patients who met the pharmacokinetic and pharmacodynamic target was 85.1%. In the whole population, a tendency to fail to reach the target was observed with a higher lean mass over height2 [OR = 0.79; 95% CI (0.62-1.01); P = 0.060]. In the female subgroup, higher lean mass over height2 [OR = 0.63; 95% CI (0.41-0.97); P = 0.037] and the presence of a metabolic syndrome [OR = 0.17; 95% CI (0.03-0.83); P = 0.030] were associated with failure to reach the pharmacokinetic and pharmacodynamic target. CONCLUSION Obese patients with a higher lean mass and a metabolic syndrome could constitute a subgroup at risk for cefoxitin under-dosage.
Collapse
Affiliation(s)
- Thibaut Belveyre
- Department of Anaesthesiology, critical care and peri-operative medicine, Surgical Intensive Care Unit JM Picard, University Hospital of Nancy, 54511, Vandœuvre-Lès-Nancy, France.
| | - Julien Scala-Bertola
- Department of Clinical Pharmacology and Toxicology, University Hospital of Nancy, 54000, Nancy, France
- Université de Lorraine, CNRS, IMoPA, 54000, Nancy, France
| | - Mathieu Esposito
- Department of Anaesthesiology, critical care and peri-operative medicine, Surgical Intensive Care Unit JM Picard, University Hospital of Nancy, 54511, Vandœuvre-Lès-Nancy, France
| | - Amandine Luc
- DRCI, MPI department, Methodology, Data Management and Statistic Unit, University Hospital of Nancy, 54511, Vandœuvre-Lès-Nancy, France
| | - Jeffrey Lipman
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Scientific Consultant, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Emmanuel Novy
- Department of Anaesthesiology, critical care and peri-operative medicine, Surgical Intensive Care Unit JM Picard, University Hospital of Nancy, 54511, Vandœuvre-Lès-Nancy, France
- Université de Lorraine, SIMPA, Stress Immunity Pathogens unit, EA 7300, 54000, Nancy, France
| |
Collapse
|
3
|
Ferraz ÁAB, Santa-Cruz F, Edmiston CE. Antibiotic Prophylaxis in Bariatric Surgical Procedures: Is There an Ideal Antimicrobial Agent? Surg Infect (Larchmt) 2020; 21:654-658. [PMID: 32109196 DOI: 10.1089/sur.2019.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
When patients with significant comorbid risk factors undergo surgical procedures, they are at high risk for development of post-operative infectious complications, including surgical site infection (SSI). Obese patients characteristically fit within this risk category, and thus it is of paramount importance to establish evidence-based strategies to mitigate these infectious complications. The use of an antimicrobial prophylactic regimen is a well-established practice and is based on the principle of the "right drug, at the right time, in the right place." The subject of this article is to review the current evidence-based data on antimicrobial prophylaxis in obese patients undergoing bariatric surgical procedures.
Collapse
Affiliation(s)
- Álvaro A B Ferraz
- Department of Surgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Fernando Santa-Cruz
- Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Charles E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
4
|
Belveyre T, Guerci P, Pape E, Thilly N, Hosseini K, Brunaud L, Gambier N, Meistelman C, Losser MR, Birckener J, Scala-Bertola J, Novy E. Antibiotic prophylaxis with high-dose cefoxitin in bariatric surgery: an observational prospective single center study. Antimicrob Agents Chemother 2019:AAC. [PMID: 31591127 DOI: 10.1128/AAC.01613-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The optimal dose of cefoxitin for antibiotic prophylaxis in obese patients remains uncertain. We evaluated the adequacy of a 4-gram dosing regimen of cefoxitin against the most frequent pathogens that infect patients undergoing bariatric surgery. METHODS This observational prospective study included obese patients who required bariatric surgery and a 4-gram dose of cefoxitin as an antibiotic prophylaxis. Serum concentrations were measured during surgery (incision, wound closure and in case of reinjection). The pharmacokinetic/pharmacodynamic (PK/PD) target was to obtain free cefoxitin concentrations above 4× MIC, from incision to wound closure (100% ƒT>4xMIC). The targeted MIC was based on the worst-case scenario (the highest ECOFF value of Staphylococcus aureus, Enterobacteriaceae and anaerobic bacteria). The secondary outcomes were the factors related to underdosage. RESULTS Two hundred patients were included. The mean age of the patients was 46 (±12) years-old, and the mean BMI was 45.8 (±6.9) kg/m2 Bypass surgery was the preferred technique (84%). The percentages of patients who met the PK/PD target (100% fT>4xMIC) of cefoxitin were 37.3%, 1.1% and 0% for S. aureus, Enterobacteriaceae and anaerobic bacteria, respectively. BMIs below 50 kg/m2 (OR 0.29, 95% CI [0.11-0.75], P = 0.0107) and a shorter duration of surgery (OR 0.97, 95% CI [0.95-0.99], P = 0.004) were associated with reaching the target concentrations. CONCLUSIONS In obese patients undergoing bariatric surgery, a regimen of 4 grams of cefoxitin led to an inadequate coverage for most common pathogens. A longer surgery duration and BMI over 50 kg/m2 increase the risk of underdosage.
Collapse
|
5
|
Mehta S, Aranzana-Climent V, Rammaert B, Grégoire N, Marchand S, Couet W, Buyck JM. Preclinical Pharmacokinetic and Pharmacodynamic Data To Support Cefoxitin Nebulization for the Treatment of Mycobacterium abscessus. Antimicrob Agents Chemother 2019; 63:e02651-18. [PMID: 31061149 DOI: 10.1128/AAC.02651-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/27/2019] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium abscessus is responsible for difficult-to-treat chronic pulmonary infections in humans. Current regimens, including parenteral administrations of cefoxitin (FOX) in combination with amikacin and clarithromycin, raise compliance problems and are frequently associated with high failure and development of resistance. Aerosol delivery of FOX could be an interesting alternative. FOX was administered to healthy rats by intravenous bolus or intratracheal nebulization, and concentrations were determined in plasma and epithelial lining fluid (ELF) by liquid chromatography-tandem mass spectrometry. After intrapulmonary administration, the FOX area under the curve within ELF was 1,147 times higher than that in plasma, indicating that this route of administration offers a biopharmaceutical advantage over intravenous administration. FOX antimicrobial activity was investigated using time-kill curves combined with a pharmacokinetic/pharmacodynamic (PK/PD) type modeling approach in order to account for its in vitro instability that precludes precise determination of MIC. Time-kill data were adequately described by a model including in vitro degradation, a sensitive (S) and a resistant (R) bacteria subpopulation, logistic growth, and a maximal inhibition-type growth inhibition effect of FOX. Median inhibitory concentrations were estimated at 16.2 and 252 mg/liter for the S and R subpopulations, respectively. These findings suggest that parenteral FOX dosing regimens used in patients for the treatment of M. abscessus are not sufficient to reduce the bacterial burden and that FOX nebulization offers a potential advantage that needs to be further investigated.
Collapse
|
6
|
Kiriazopoulos E, Zaharaki S, Vonaparti A, Vourna P, Panteri-Petratou E, Gennimata D, Lombardo K, Panderi I. Quantification of three beta-lactam antibiotics in breast milk and human plasma by hydrophilic interaction liquid chromatography/positive-ion electrospray ionization mass spectrometry. Drug Test Anal 2016; 9:1062-1072. [DOI: 10.1002/dta.2104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Evaggelos Kiriazopoulos
- National and Kapodistrian University of Athens; Faculty of Pharmacy; Laboratory of Pharmaceutical Analysis; Athens Greece
| | - Sabina Zaharaki
- National and Kapodistrian University of Athens; Faculty of Pharmacy; Laboratory of Pharmaceutical Analysis; Athens Greece
| | - Ariadni Vonaparti
- National and Kapodistrian University of Athens; Faculty of Pharmacy; Laboratory of Pharmaceutical Analysis; Athens Greece
- Qatar Doping Analysis Laboratory; Doha Qatar
| | - Panagiota Vourna
- General - Maternity District Hospital Elena Venizelou; Milk Bank and Maternal Breast-feeding Department; Athens Greece
| | | | - Dimitra Gennimata
- General Hospital ‘Korgialenio-Benakio National Red Cross’; Athens Greece
| | - Kara Lombardo
- Brown University; Warren Alpert Medical School; Department of Pathology; Rhode Island Hospital; Providence RI USA
| | - Irene Panderi
- National and Kapodistrian University of Athens; Faculty of Pharmacy; Laboratory of Pharmaceutical Analysis; Athens Greece
| |
Collapse
|