title: Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery.
abstract: OBJECTIVE
  To estimate the adequacy of antimicrobial activity of preoperative antibiotics at the time of cesarean delivery as a function of maternal obesity.
  
  
  METHODS
  Twenty-nine patients scheduled for cesarean delivery were stratified according to body mass index (BMI) category, with 10 study participants classified as lean (BMI less than 30), 10 as obese (BMI 30-39.9), and nine as extremely obese (BMI 40 or higher). All patients were given a dose of 2 g cefazolin 30-60 minutes before skin incision. Antibiotic concentrations from adipose samples, collected after skin incision and before skin closure, along with myometrial and serum samples, were analyzed with microbiological agar diffusion assay.
  
  
  RESULTS
  Cefazolin concentrations within adipose tissue obtained at skin incision were inversely proportional to maternal BMI (r=-0.67, P<.001). The mean adipose concentration was 9.4 plus or minus 2.7 micrograms/g in the lean group of women compared with 6.4 plus or minus 2.3 micrograms/g in the obese group (P=.009) and 4.4 plus or minus 1.2 micrograms/g in the extremely obese group (P<.001). Although all specimens demonstrated therapeutic cefazolin levels for gram-positive cocci (greater than 1 microgram/g), a considerable portion of obese and extremely obese did not achieve minimal inhibitory concentrations of greater than 4 micrograms/g for Gram-negative rods in adipose samples at skin incision (20% and 33.3%, respectively) or closure (20.0% and 44.4%, respectively). No significant difference in cefazolin concentration was observed in mean closure adipose, myometrial, or serum specimens across the BMI categories.
  
  
  CONCLUSIONS
  Pharmacokinetic analysis suggests that present antibiotic prophylaxis dosing may fail to provide adequate antimicrobial coverage in obese patients during cesarean delivery.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT00980486.
  
  
  METHODS
  II.
authors.affiliation: From the Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California; Surgical Microbiology Research Laboratory, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and the Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center, Long Beach, California.
authors.forename: Leo
authors.initials: L
authors.lastname: Pevzner
authors.forename: Morgan
authors.initials: M
authors.lastname: Swank
authors.forename: Candace
authors.initials: C
authors.lastname: Krepel
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wing
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chan
authors.forename: Charles E
authors.initials: CE
authors.lastname: Edmiston
mesh_terms: D050154:Adiposity / Q000187:drug effects; D000328:Adult; D000886:Anthropometry; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015992:Body Mass Index; D002437:Cefazolin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002437:Cefazolin