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
1460-2091
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
C1
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
Microbiology
Pharmacology & Pharmacy
antibiotic prophylaxis
intraoperative period
drug administration schedule
adult burns
Wound Manipulation
Pharmacodynamics
Bacteremia
Infection
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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Created: Mon, 18 Feb 2008, 14:27:21 EST