Oral antibiotic prophylaxis can influence the inflammatory response in aortic aneurysm repair: results of a randomized clinical study.
The purpose of this prospective, randomized study was to evaluate the effect of oral ofloxacin prophylaxis on endotoxin/cytokine release in aortic aneurysm repair, in 25 patients with infrarenal aortic aneurysm at a University hospital. Outcome parameters included complications after operation; endotoxin and endotoxin neutralizing capacity, IL-6, procalciton and neopterin. All patients had the standard perioperative antibiotic prophylaxis (2 g cefotiam). 12 patients randomly received oral ofloxacin prophylaxis (group 1) the day before the operation (200 mg/2x12h); 13 patients were controls (group 2). Data were analyzed by chi-square analysis, Mann-Whitney and Wilcoxon analysis. Ofloxacin had no effect on the occurrence of complications or on the peripheral endotoxin levels. Ofloxacin-treated patients showed increased endotoxin neutralizing capacity (ENC) 30 min after clamping compared to controls (15.8+/-15 vs 262.8+/-709 p=0.005) and increased IL-6 levels preoperatively and 30 min after clamping. Patients with complications had significantly higher IL-6 levels early during the operation and postoperatively (30 min after clamping: 36.4+/-15.1 vs 18.8+/-11.9 pg/ml p=0.01; 2nd postoperative day: 768+/-688 vs 225+/-322 pg/ml p=0.005). Ofloxacin prophylaxis had no effect on procalcitonin, or neopterin plasma levels. Neither procalcitonin nor neopterin could detect patients with complications IL-6 plasma levels predicted the occurrence of complications in aortic aneurysm repair. Oral ofloxacin prophylaxis may influence the ENC and IL-6 plasma levels but had no effect on complications, endotoxin and other inflammatory mediators.
Holzheimer
R G
RG
Medical Faculty, Martin-Luther University, Halle-Wittenberg, Germany. gresser.holzheimer@t-online.de
D000284:Administration, Oral; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001014:Aortic Aneurysm / Q000382:microbiology* / Q000601:surgery*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D004731:Endotoxins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D008297:Male; D019798:Neopterin / Q000097:blood; D015242:Ofloxacin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood
D000890:Anti-Infective Agents; C000606589:CALCA protein, human; D016207:Cytokines; D004731:Endotoxins; D015850:Interleukin-6; D011498:Protein Precursors; D019798:Neopterin; D002116:Calcitonin; D015242:Ofloxacin; D015740:Calcitonin Gene-Related Peptide