The myth of the second prophylactic antibiotic dose in aortoiliac reconstructions.
OBJECTIVE
To determine whether a prophylactic second dose of antibiotics is justified when severe blood loss and/or prolonged operation time occurs during aortoiliac reconstructions.


METHODS
We measured the cefuroxime concentration in venous blood serum and subcutaneous fat tissue of 30 patients who underwent elective aortoiliac reconstruction after a single intravenous dose of 1500 mg cefuroxime.


RESULTS
The mean blood loss was 1912 ml (range 200-7000). The mean operation time was 212 min (range 70-330). The cefuroxime concentration in blood serum 30 min after the gift varied from 53.7-561.6 mg/l and during closure of the abdominal incision from 13.2-90.0 mg/l. Taking the minimum inhibitory concentration for Staphylococcus species as 1.0 mg/l, we found an adequate prophylactic serum cefuroxime concentration in all patients. There was a statistically significant correlation between serum cefuroxime concentration and blood loss (p = 0.01) and operation time (p = 0.0001).


CONCLUSIONS
Although serum concentration of cefuroxime is greatly influenced by blood loss and operation time, a second dose of cefuroxime in aortoiliac reconstructions is not necessary if the operation is completed within 5.5 h and if perioperative blood loss does not exceed 7000 ml.
van Dijk-van Dam
M S
MS
Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Moll
F L
FL
de Letter
J A
JA
Langemeijer
J J
JJ
Kuks
P F
PF
D000273:Adipose Tissue / Q000737:chemistry; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D016063:Blood Loss, Surgical; D001807:Blood Vessel Prosthesis; D002444:Cefuroxime / Q000008:administration & dosage* / Q000032:analysis; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011292:Premedication; D011446:Prospective Studies; D012044:Regression Analysis; D013530:Surgical Wound Infection / Q000517:prevention & control*
D002444:Cefuroxime