Dosing antibiotic prophylaxis during cardiopulmonary bypass—a higher level of complexity? A structured review

Paruk, Fathima, Sime, Fekade B., Lipman, Jeffrey and Roberts, Jason A. (2017) Dosing antibiotic prophylaxis during cardiopulmonary bypass—a higher level of complexity? A structured review. International Journal of Antimicrobial Agents, 49 4: 395-402. doi:10.1016/j.ijantimicag.2016.12.014


Author Paruk, Fathima
Sime, Fekade B.
Lipman, Jeffrey
Roberts, Jason A.
Title Dosing antibiotic prophylaxis during cardiopulmonary bypass—a higher level of complexity? A structured review
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 0924-8579
1872-7913
Publication date 2017-02-27
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ijantimicag.2016.12.014
Open Access Status Not yet assessed
Volume 49
Issue 4
Start page 395
End page 402
Total pages 8
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Collection year 2018
Language eng
Formatted abstract
In highly invasive procedures such as open heart surgery, the risk of post-operative infection is particularly high due to exposure of the surgical field to multiple foreign devices. Adequate antibiotic prophylaxis is an essential intervention to minimise post-operative morbidity and mortality. However, there is a lack of clear understanding on the adequacy of traditional prophylactic dosing regimens, which are rarely supported by data. The aim of this structured review is to describe the relevant pharmacokinetic/pharmacodynamic (PK/PD) considerations for optimal antibiotic prophylaxis for major cardiac surgery including cardiopulmonary bypass (CPB). A structured review of the relevant published literature was performed and 45 relevant studies describing antibiotic pharmacokinetics in patients receiving extracorporeal CPB as part of major cardiac surgery were identified. Some of the studies suggested marked PK alterations in the peri-operative period with increases in volume of distribution (Vd) by up to 58% and altered drug clearances of up to 20%. Mechanisms proposed as causing the PK changes included haemodilution, hypothermia, retention of the antibiotic within the extracorporeal circuit, altered physiology related to a systemic inflammatory response, and maldistribution of blood flow. Of note, some studies reported no or minimal impact of the CPB procedure on antibiotic pharmacokinetics. Given the inconsistent data, ongoing research should focus on clarifying the influence of CPB procedure and related clinical covariates on the pharmacokinetics of different antibiotics during cardiac surgery. Traditional prophylactic dosing regimens may need to be re-assessed to ensure sufficient drug exposures that will minimise the risk of surgical site infections.
Keyword Pharmacokinetics
Extracorporeal therapy
Cardiac surgery
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
School of Medicine Publications
School of Pharmacy Publications
 
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Created: Tue, 07 Mar 2017, 18:17:22 EST by Fekade Sime on behalf of School of Pharmacy