title: Serum in vivo and in vitro activity of single dose of ertapenem in surgical obese patients for prevention of SSIs.
abstract: BACKGROUND
  Despite progress made in the control of post-operative infections, the incidence of surgical site infections (SSIs) is still high. An improper perioperative antibiotic use can expose patients to the risk of resistant microorganisms, and, in surgical obese patients, the drug dosage and infusion time are critical points. The aim of our study was to evaluate the effectiveness of ertapenem in the prophylaxis of SSIs in obese patients undergoing general or bariatric surgery.
  
  
  METHODS
  A total of 63 obese patients, candidates for several surgical interventions, were enrolled and divided into two groups. Patients received antibiotic prophylaxis before surgery: the case group received venous infusion of ertapenem; the control group received standard prophylaxis. Serum samples were tested for antimicrobial activity against Gram-positive and Gram-negative bacteria.
  
  
  RESULTS
  After single-dose ertapenem in obese patients, we registered in vitro activity of sera against the growth of non-extended beta lactamase (ESBL)-producing Escherichia coli, Proteus mirabilis, Citrobacter freundii, Enterobacter cloacae, and non-ESBL-producing Klebsiella pneumoniae. Moreover, methicillin-sensitive Staphylococcus aureus and Streptococcus viridans were also inhibited. We found in vivo efficacy according to clinical monitoring: at the weekly and monthly follow-ups, one patient in the case group and six patients in the control group presented superficial incisional SSIs.
  
  
  CONCLUSIONS
  These preliminary results are suggestive of the efficacy of ertapenem in perioperative prophylaxis of SSIs in obese patients; however, they need to be confirmed by further investigations and more defined trials.
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Federico II University, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Werra
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Micco
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pilone
authors.forename: Antonio
authors.initials: A
authors.lastname: Formato
authors.forename: Emma
authors.initials: E
authors.lastname: Montella
authors.forename: Antonietta
authors.initials: A
authors.lastname: Lambiase
authors.forename: Domenica
authors.initials: D
authors.lastname: Cerbone
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Catania
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000005:Abdomen / Q000382:microbiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D050110:Bariatric Surgery / Q000009:adverse effects*; D016972:Enterobacter cloacae / Q000302:isolation & purification; D000077727:Ertapenem; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011513:Proteus mirabilis / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077727:Ertapenem