Inadequate antimicrobial prophylaxis during surgery: a study of beta-lactam levels during burn debridement

Dalley, Andrew J., Lipman, Jeffrey, Venkatesh, Bala, Rudds, Michael, Roberts, Michael S. and Cross, Sheree E. (2007) Inadequate antimicrobial prophylaxis during surgery: a study of beta-lactam levels during burn debridement. Journal of Antimicrobial Chemotherapy, 60 1: 166-169. doi:10.1093/jac/dkm128

Author Dalley, Andrew J.
Lipman, Jeffrey
Venkatesh, Bala
Rudds, Michael
Roberts, Michael S.
Cross, Sheree E.
Title Inadequate antimicrobial prophylaxis during surgery: a study of beta-lactam levels during burn debridement
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
Publication date 2007-05-15
Sub-type Article (original research)
DOI 10.1093/jac/dkm128
Volume 60
Issue 1
Start page 166
End page 169
Total pages 4
Editor Johnson, A.P.
Place of publication Oxford, U.K.
Publisher Oxford Universtiy Press
Collection year 2008
Language eng
Subject 320503 Clinical Pharmacology and Therapeutics
730109 Surgical methods and procedures
Abstract Objectives: To determine how long single-dose prophylactic antibiotic regimens for burns surgery maintained plasma concentrations above the MICs for target organisms during surgery. Patients and methods: We monitored antibiotic plasma concentrations in 12 patients (mean +/- SD 43 +/- 12% total burn surface area) throughout debridement surgery after administration of the standard prophylactic antibiotic dosing regimens of either 1 g of intravenous cefalotin or 4.5 g of intravenous piperacillin/tazobactam. Results: The eschar debridement and grafting procedures ranged in duration from 2.25 to over 8.5 h. The duration of total plasma cefalotin concentration above an MIC of 0.2 mg/L for Staphylococcus aureus was 6.49 +/- 2.85 h, whereas the mean duration of total plasma piperacillin concentration above an MIC of 64 mg/L for Pseudomonas aeruginosa was only 1.15 +/- 0.59 h. None of the patients dosed with piperacillin/tazobactam was adequately protected for the duration of their surgery and adequate prophylaxis was only evident in four of the nine patients administered cefalotin. Conclusions: These results suggest a need to review antibiotic prophylaxis dosage regimens for burns surgery and the adoption of regimens that will minimize the risk of infection in this high-risk patient group. It is suggested that the antibiotic prophylaxis guideline for burn debridement surgery be modified to include re-dosing or a continuous infusion of P-lactam antibiotics.
Keyword Infectious Diseases
Pharmacology & Pharmacy
antibiotic prophylaxis
intraoperative period
drug administration schedule
adult burns
Wound Manipulation
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 18 Feb 2008, 14:27:21 EST