Inadequate antimicrobial prophylaxis during surgery: a study of beta-lactam levels during burn debridement.
OBJECTIVE
To determine how long single-dose prophylactic antibiotic regimens for burns surgery maintained plasma concentrations above the MICs for target organisms during surgery.


METHODS
We monitored antibiotic plasma concentrations in 12 patients (mean +/- SD 43 +/- 12% total burn surface area) throughout debridement surgery after administration of the standard prophylactic antibiotic dosing regimens of either 1 g of intravenous cefalotin or 4.5 g of intravenous piperacillin/tazobactam.


RESULTS
The eschar debridement and grafting procedures ranged in duration from 2.25 to over 8.5 h. The duration of total plasma cefalotin concentration above an MIC of 0.2 mg/L for Staphylococcus aureus was 6.49 +/- 2.85 h, whereas the mean duration of total plasma piperacillin concentration above an MIC of 64 mg/L for Pseudomonas aeruginosa was only 1.15 +/- 0.59 h. None of the patients dosed with piperacillin/tazobactam was adequately protected for the duration of their surgery and adequate prophylaxis was only evident in four of the nine patients administered cefalotin.


CONCLUSIONS
These results suggest a need to review antibiotic prophylaxis dosage regimens for burns surgery and the adoption of regimens that will minimize the risk of infection in this high-risk patient group. It is suggested that the antibiotic prophylaxis guideline for burn debridement surgery be modified to include re-dosing or a continuous infusion of beta-lactam antibiotics.
Dalley
Andrew J
AJ
Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.
Lipman
Jeffrey
J
Venkatesh
Bala
B
Rudd
Michael
M
Roberts
Michael S
MS
Cross
Sheree E
SE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D002056:Burns / Q000601:surgery*; D002512:Cephalothin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D003646:Debridement / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013211:Staphylococcus aureus / Q000187:drug effects; D000078142:Tazobactam; D047090:beta-Lactams / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D010397:Penicillanic Acid; D002512:Cephalothin; D000078142:Tazobactam; D010878:Piperacillin