Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review

Fischer, María Isabel; Dias, Cícero; Stein, Airton Tetelbom; Meinhardt, Nelson Guardiola; Heineck, Isabela

doi:10.1590/s0102-86502014000300010

Cited by 26 publications

(13 citation statements)

References 18 publications

(40 reference statements)

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“…Obesity is a risk factor for nosocomial infections, particularly surgical‐site infections. The frequency of these infections in obese patients ranges from 1 to 21·7 per cent, depending on the procedure. Antibiotic prophylaxis significantly reduces surgical‐site infections after elective surgery and should follow standard guidelines for perioperative antimicrobial prophylaxis.…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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“…and Streptococcus spp. (24). Further, ertapenem covers most of the common microbial spectrum found in intra-abdominal infections with peritonitis (25,26).…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics and Target Attainment of Ertapenem in Plasma and Tissue Assessed via Microdialysis in Morbidly Obese Patients after Laparoscopic Visceral Surgery

Wittau

Paschke

Kurlbaum

et al. 2017

Antimicrob Agents Chemother

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Ertapenem provides broad-spectrum activity against many pathogens, and its use is relevant for the prophylaxis and treatment of infections in morbidly obese patients undergoing surgery. However, its pharmacokinetics and tissue penetration in these patients are not well defined. We assessed the population pharmacokinetics and target attainment for ertapenem in the plasma, subcutaneous tissue, and peritoneal fluid of morbidly obese patients. Six female patients (body mass index, 43.7 to 55.9 kg/m 2 ) received 1,000 mg ertapenem as 15-min infusions at 0 and 26 h. On day 2, the unbound ertapenem concentrations in plasma, subcutaneous tissue, and peritoneal fluid were measured by microdialysis; total plasma concentrations were additionally quantified. The probability of attaining a target of an unbound ertapenem concentration above the MIC for at least 40% of the dosing interval was predicted via Monte Carlo simulations. The population pharmacokinetic model contained two disposition compartments and simultaneously described all concentrations. For unbound ertapenem, total clearance was 12.3 liters/h (coefficient of variation, 21.6% for between-patient variability) and the volume of distribution at steady state was 57.8 liters in patients with a 53-kg fat-free mass. The area under the concentration-time curve (AUC) for ertapenem was 49% lower in subcutaneous tissue and 25% lower in peritoneal fluid than the unbound AUC in plasma. Tissue penetration was rapid (equilibration half-life, Ͻ15 min) and was variable in subcutaneous tissue. Short-term ertapenem infusions (1,000 mg every 24 h) achieved robust (Ͼ90%) target attainment probabilities for MICs of up to 1 mg/liter in plasma, 0.25 to 0.5 mg/liter in subcutaneous tissue, and 0.5 mg/liter in peritoneal fluid. Ertapenem presents an attractive choice for many pathogens relevant to morbidly obese patients undergoing surgery. (This study has been registered at ClinicalTrials.gov under identifier NCT01407965.) KEYWORDS ertapenem, morbidly obese patients, population pharmacokinetics, subcutaneous tissue, microdialysis, S-ADAPT, Monte Carlo simulation, pharmacodynamics E rtapenem covers many bacterial pathogens, and its use is relevant for the prophylaxis and treatment of infections in morbidly obese patients undergoing laparoscopic visceral surgery (1). Ertapenem has a relatively high level of protein binding

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“…Although guidelines recommend routine antibiotic prophylaxis during bariatric procedures, the evidence belongs to open surgery times. [3][4][5][6] To the best of our knowledge, there is no prospective randomized study demonstrating the beneficial influence of antibiotic prophylaxis during laparoscopic bariatric procedures. Further studies are necessary about the necessity, drug selection and dosages of the antibiotic prophylaxis.…”

Section: Before the Scalpelmentioning

confidence: 99%