Abstract
Surgical-site infections are very serious complications of cardiac operations. Use of cardiopulmonary bypass (CPB) is associated with profound physiological changes, which affects the pharmacokinetic behaviour of prophylactic antibiotics. The aim of this study was to monitor tissue concentrations of cefuroxime in peripheral tissue (skeletal muscle) during cardiac surgery using CPB by means of a microdialysis. Eleven adult patients operated on using CPB were included in the study. Cefuroxime was the prophylactic antibiotic and study drug given. Microdialysis was performed by probe CMA 60 inserted into the patient's left deltoid muscle. Samples of dialysates were collected at intervals: before CPB, each 30 minutes of CPB and at the end of CPB. Samples of blood were collected at intervals: incision, start of CPB, each 30 minutes of CPB, at the end of CPB and at the end of surgery. The mean (+/- S.D.) concentrations of cefuroxime in peripheral tissue were 105.4+/-41.1, 81.7+/-32.8, 74.6+/-26.0, 70.4+/-34.7, 60.5+/-27.2, 138.0+/-42.6 (mg l(-1)). Total plasma concentrations of cefuroxime were 154.4+/-41.6, 73.3+/-20.7, 67.1+/-20.4, 59.2+/-21.0, 49.0+/-16.4, 110.9+/-33.6 (mg l(-1)) and concentrations of free plasma fraction were 110.7+/-37.1, 62.2+/-18.8, 58.9+/-18.6, 48.4+/-16.6, 41.7+/-15.6, 97.6+/-28.6 (mg l(-1)). The plasma and tissue concentrations exceed throughout the operation time the minimum inhibitory concentration for most common suspected pathogens in cardiac surgery. Results show that CPB can modify the time course of cefuroxime tissue and plasma concentrations. Microdialysis is suitable for antibiotic tissue measurement in cardiac surgery.
Highlights
Wound and mediastinal infections along with postoperative endocarditis are very serious complications of cardio surgical operations with life-threatening consequences for the patient
Patients were excluded from the study if they had received any treatment with any antibiotics within the 14 days prior to the start of the study, or had allergic or hypersensitive reaction to β-lactam antibiotics in their history
Antibiotic prophylaxis against bacterial infections has become the standard method for protecting patients during cardiac surgery and in the early postoperative period
Summary
Wound and mediastinal infections along with postoperative endocarditis are very serious complications of cardio surgical operations with life-threatening consequences for the patient. The incidence of sternal infection after cardiac operations ranges from 0.9 % to 20 % in various studies and the incidence of mediastinitis is 1–2 % in most reports[1]. The mortality rate for patients with deep sternal infections ranges from 9.8 to 14 %2. These infectious complications require repeated surgical intervention accompanied by aggressive pharmacological treatment. The aim of the prophylaxis is to achieve levels of the free plasma and target site concentrations of antibiotic (ATB) in soft tissue, which exceed the minimum inhibitory concentration (MIC) for the most common suspected pathogens and to maintain these concentrations throughout the operation. Cephalosporins (beta-lactam antibiotics) are frequently used in cardiac surgery for their broad spectrum of activity and low degrees of toxicity[4, 5]
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