title: The efficacy of post-cardiopulmonary bypass dosing of vancomycin in cardiac surgery.
abstract: Objective. Vancomycin is administered widely to patients undergoing cardiac surgery as prophylaxis against resistant Gram-positive sternal wound and venous donor site infections. The purpose of this study was to determine the efficacy of a standardized prebypass and postbypass dosing regimen of vancomycin by assessing plasma concentrations in the immediate postoperative period and postoperative surgical site infections (SSIs). Design. Retrospective cohort study. Setting . Cardiothoracic surgical intensive care unit in a tertiary care academic medical center. Methods. A total of 34 consecutive adult patients who had undergone cardiac surgery with cardiopulmonary bypass (CPB) were analyzed retrospectively. Each patient received 1000 mg of vancomycin administered over 1 hour around the time of induction of anesthesia and 500 mg after discontinuation of CPB. Trough vancomycin levels were sampled in the intensive care unit 12 hours after the last dose given in the operating room. Along with patient characteristics, postoperative readmission rates and SSIs were recorded for 1 year after surgery. Results. The nadir serum vancomycin level before the next dose was 9.3 ± 4.5 µg/mL (mean ± standard deviation). One superficial SSI was noted. Readmission rate for SSIs was 2.94%. Conclusion . Vancomycin concentrations in the serum were greater than the minimum inhibitory concentration for most staphylococci ranging from 4 to 19.3 µg/mL producing acceptable therapeutic serum concentrations and low rate of infectious complications. Thus postbypass dosing is acceptable in vancomycin cardiac surgical prophylaxis.
authors.affiliation: Mount Sinai School of Medicine, New York, NY, USA. jayashree.raikhelkar@mountsinai.org
authors.forename: Jayashree K
authors.initials: JK
authors.lastname: Raikhelkar
authors.forename: David L
authors.initials: DL
authors.lastname: Reich
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schure
authors.forename: Robin
authors.initials: R
authors.lastname: Varghese
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015331:Cohort Studies; D003325:Coronary Care Units; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014640:Vancomycin / Q000097:blood / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin