Cefazolin prophylaxis in children undergoing cardiac surgery: neither too little nor too late.

Abstract

We thank Suna and Alphonso [1] for their valuable comments concerning our study [2]. They write that antibiotic prophylaxis protocols should be reviewed or maybe even changed for many other children’s groups in paediatric cardiac surgery. Indeed! But first, we wanted to answer the question whether the concentration of cefazolin during paediatric cardiac surgery with cardiopulmonary bypass (CPB) using the standard antibiotic prophylaxis protocol reaches the threshold of antimicrobial activity. Because ethical concerns regarding paediatric pilot studies limited the group size, we selected a group as homogeneous as possible, in which not too many factors could influence the cefazolin concentration during surgery. If these preliminary results showed that standard protocols were not correct, then it would justify further studies, i.e. in newborns, patients operated on in deep hypothermia, children needing antibiotic redosing during surgery because of long operation times in the most complex paediatric cardiac surgical cases and patients with the sternum left open.