title: Antibiotic prophylaxis in bariatric surgery with continuous infusion of cefazolin: determination of concentration in adipose tissue.
abstract: BACKGROUND
  The aim of this study was to evaluate the concentration of cefazolin in adipose tissue of patients undergoing bariatric surgery.
  
  
  METHODS
  Eighteen patients undergoing bariatric surgery were evaluated during the period from October 2011 to May 2012. All patients had a dosage schedule of antibiotic prophylaxis with cefazolin administered as follows: first, 2 g in anesthetic induction, followed by continuous infusion of 1 g diluted in 250 ml of saline solution. Adipose samples, collected soon after the incision (initial) and before the skin synthesis (final), were analyzed using reverse phase high-pressure liquid chromatography. The level of significance adopted was 5 %.
  
  
  RESULTS
  The cefazolin concentration in the adipose tissue samples at the beginning of surgery was an average of 6.66 ± 2.56 ug/ml. The mean concentration before the skin synthesis was 7.93 ± 2.54 ug/ml. Patients with BMI < 40 kg/m(2) had higher initial and final sample concentrations of cefazolin than patients with BMI ≥ 40 kg/m(2). There was no surgical site infection (SSI) in any of the patients.
  
  
  CONCLUSIONS
  In bariatric surgeries, addition of a 1 g increase of cefazolin, administered through continuous intravenous infusion, to the currently recommended dose of 2 g administered in anesthetic induction provided a concentration in the adipose tissue above the minimum inhibitory concentration (MIC) of the main causal agents of SSI. An inverse correlation between BMI and concentration of cefazolin in adipose tissue was observed.
authors.affiliation: Department of Plastic Surgery, UFPE, Recife, Pernambuco, Brazil, rafaelanlicoara@hotmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Anlicoara
authors.forename: Álvaro A B
authors.initials: ÁA
authors.lastname: Ferraz
authors.forename: Kilma
authors.initials: K
authors.lastname: da P Coelho
authors.forename: José L
authors.initials: JL
authors.lastname: de Lima Filho
authors.forename: Luciana T
authors.initials: LT
authors.lastname: Siqueira
authors.forename: José G C
authors.initials: JG
authors.lastname: de Araújo
authors.forename: Josemberg M
authors.initials: JM
authors.lastname: Campos
authors.forename: Edmundo M
authors.initials: EM
authors.lastname: Ferraz
mesh_terms: D000273:Adipose Tissue / Q000737:chemistry*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000032:analysis* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D050110:Bariatric Surgery / Q000379:methods*; D002437:Cefazolin / Q000032:analysis* / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin
references.citation: Obes Surg. 2012 Mar;22(3):465-71
references.pmid: 22249886
references.citation: Surg Infect (Larchmt). 2002 Spring;3(1):5-9
references.pmid: 12593694
references.citation: Obes Surg. 2004 Jan;14(1):16-22
references.pmid: 14980028
references.citation: Anesth Analg. 2011 Oct;113(4):730-7
references.pmid: 21642605
references.citation: Eur J Clin Pharmacol. 2011 Oct;67(10):985-92
references.pmid: 21499760
references.citation: Int J Antimicrob Agents. 2009 Sep;34(3):231-5
references.pmid: 19411164
references.citation: Antimicrob Agents Chemother. 2006 Apr;50(4):1222-7
references.pmid: 16569832
references.citation: Int J Antimicrob Agents. 2007 Jul;30(1):11-8
references.pmid: 17442541
references.citation: Surg Infect (Larchmt). 2012 Feb;13(1):33-7
references.pmid: 22316145
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2010 Jun;10(3):317-28
references.pmid: 20545596
references.citation: J Antimicrob Chemother. 2011 Oct;66(10):2330-5
references.pmid: 21729931
references.citation: Antimicrob Agents Chemother. 1984 Nov;26(5):652-5
references.pmid: 6517553
references.citation: Int J Antimicrob Agents. 2002 Apr;19(4):285-90
references.pmid: 11978499
references.citation: Surg Infect (Larchmt). 2006 Oct;7(5):473-80
references.pmid: 17083313
references.citation: Pharmacotherapy. 2007 Aug;27(8):1081-91
references.pmid: 17655508
references.citation: Obstet Gynecol. 2011 Apr;117(4):877-882
references.pmid: 21422859
references.citation: Antimicrob Agents Chemother. 2007 Aug;51(8):2741-7
references.pmid: 17548489
references.citation: Antimicrob Agents Chemother. 2011 Jul;55(7):3240-3
references.pmid: 21576432
references.citation: Obes Surg. 2011 Jul;21(7):836-40
references.pmid: 20198452
references.citation: Obes Surg. 2004 Aug;14(7):970-4
references.pmid: 15329188
references.citation: Am J Health Syst Pharm. 2007 Sep 15;64(18):1927-34
references.pmid: 17823104
references.citation: Ann Surg. 2001 Sep;234(3):279-89; discussion 289-91
references.pmid: 11524581
references.citation: Am J Surg. 1996 Jun;171(6):615-22
references.pmid: 8678212
references.citation: Surgery. 2004 Oct;136(4):738-47
references.pmid: 15467657