title: ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem.
abstract: BACKGROUND
  The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective: The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection.
  
  
  METHODS
  A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities.
  
  
  RESULTS
  The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group.
  
  
  CONCLUSIONS
  The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Álvaro Antônio Bandeira
authors.initials: ÁA
authors.lastname: Ferraz
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Luciana Teixeira de
authors.initials: LT
authors.lastname: Siqueira
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Josemberg Marins
authors.initials: JM
authors.lastname: Campos
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Guido Correa de
authors.initials: GC
authors.lastname: Araújo
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Euclides Dias
authors.initials: ED
authors.lastname: Martins Filho
authors.affiliation: Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
authors.forename: Edmundo Machado
authors.initials: EM
authors.lastname: Ferraz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D000077727:Ertapenem; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013407:Sulbactam / Q000008:administration & dosage; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000667:Ampicillin; D000077727:Ertapenem; D002437:Cefazolin; D013407:Sulbactam