One gram of ceftriaxone was given intravenously to 15 patients approximately 2 h before cardiopulmonary bypass surgery. Ceftriaxone levels in plasma (mean ± standard deviation) were 60.4 ± 18.8 ,ug/ml (range, 17.0 to 96.0 ,ug/ml) at the beginning of bypass, 44.2 ± 16.6 ,ug/ml (range, 9.4 to 78.6 ,ug/ml) at the end of bypass, and 19.6 ± 9.6 ,ug/ml (range, 4.2 to 47.1 ,ug/ml) the following morning, 18.1 to 24.7 h after infusion of ceftriaxone. Concentrations in the sternal bone were 4.7 ± 2.1 ,xg/g (range, 1.0 to 10.1 ,ug/g; tissue-toplasma ratios, 0.066 ± 0.036). Concentrations in the atrial appendage were 7.7 ± 1.8 ,ug/g (range, 3.6 to 10.2 ,ug/g; tissue-to-plasma ratios, 0.143 ± 0.062). These data suggest that a single dose of ceftriaxone might be useful for prevention of infection due to susceptible pathogens.Cephalosporins are widely used for prevention of infection in patients undergoing cardiac surgery. However, microorganisms resistant to older cephalosporins such as cephalothin, cefazolin, and cefamandole sometimes cause postoperative infections in these patients (1,8,10). Bor et al. (1) reported that 13 gram-negative isolates from cases of mediastinitis after cardiac surgery were resistant to antimicrobial agents used perioperatively. Thus, newer cephalosporins may find a place in such preventive therapy.Ceftriaxone is a new cephalosporin with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. Various investigators have determined that 90% of strains of most members of the family Enterobacteriaceae are inhibited by ceftriaxone concentrations of 1 ,ug/ml (5-7) and that 90% of Staphylococcus aureus strains are inhibited by concentrations of 3.1 to 4 ,ug/ml (5, 7). The elimination half-life of ceftriaxone in normal volunteers, ranging from 6 to 8.6 h (6, 9), exceeds that of all cephalosporins studied to date. We determined levels of ceftriaxone in plasma and tissue after a single intravenous dose to patients undergoing cardiopulmonary bypass surgery. MATERIALS AND METHODSA total of 15 patients (14 men, 1 woman) scheduled for elective saphenous vein bypass grafting for coronary artery disease were given 1 g of ceftriaxone before the procedure. The patients were 49 to 68 years of age (mean ± standard deviation, 55.6 ± 8.4), weighed 53.8 to 121.8 kg (83.8 ± 13.7), and had normal renal function and no recent history of infection or antimicrobial therapy. The protocol was approved by the institutional review boards. Patients received ceftriaxone by intravenous infusion over 20 to 30 min approximately 1 h before the anticipated skin incision and 2 h before the anticipated bypass procedure. This single dose was the only perioperative antimicrobial therapy administered to these patients.Blood samples were collected in heparinized tubes. The first sample was obtained 20 to 50 min after completion of the infusion. At the time of median sternotomy, a portion of the xiphoid process was removed for determination of * Corresponding author.antibiotic concentration, and a second blood...
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