Abstract
ObjectiveTo measure the concentration of cefazolin in the anterior mediastinal adipose tissue of patients undergoing cardiac surgery, determining the variation of cefazolin concentration.MethodsTwo samples of approximately 1g of subcutaneous tissue were collected from 19 patients who underwent surgery in December 2015: the first sample was collected right after sternotomy and the second one, before sternal synthesis with steel wires. Antibiotic dosage was administered through high performance liquid chromatography.ResultsWe observed a positive and statistically significant correlation between time 1 and cefazolin concentration (r=0.489 and P=0.039). For time 2 and cefazolin concentration, there was a negative and statistically significant correlation between both variables (r=-0.793 and P<0.001). A negative correlation was also observed between body mass index and cefazolin concentration at time 2 (r=-0.510 and P=0.031). The regression model showed that every 1-minute increase in time 1 corresponded to an increase of 0.240 µg/dL in cefazolin concentration, whereas every 1-minute increase in time 2 corresponded to a reduction of 0.046 µg/dL in cefazolin concentration. As for body mass index, every 1 kg/m2 increase corresponded to a reduction of about 0.510 µg/dL in cefazolin concentration.ConclusionThere was a positive and significant correlation between the initial time of surgery and cefazolin level in the first dosage. The evaluation of the second dosage showed a negative and significant correlation between cefazolin level and the second time of dosage. The concentration of cefazolin is under the influence of body mass index.
Highlights
Mediastinitis is a serious infectious complication in the postoperative period of cardiovascular surgery[1]
A negative correlation was observed between body mass index and cefazolin concentration
The regression model showed that every 1-minute increase in time 1 corresponded to an increase of 0.240 μg/dL in cefazolin concentration, whereas every 1-minute increase in time 2 corresponded to a reduction of 0.046 μg/dL in cefazolin concentration
Summary
Mediastinitis is a serious infectious complication in the postoperative period of cardiovascular surgery[1]. The overall incidence of deep sternal wound infections (DSWI) ranges from 0.4% to 5%. Damage to patients and hospital costs are substantial[2]. Antibiotic prophylaxis is one of the main preventive measures. The importance of prophylactic antibiotics for cardiac surgery has been widely studied in Brazil by Sá et al.[2], who evaluated several studies carried out over the last 30 years. The use of different antibiotics to the same end clearly indicates that there is no consensus on the efficacy and safety of each one[3]. There is still no absolute certainty that the main antibiotics used effectively reach the tissues where infection occurs
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