ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

Abstract

-Background -The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective -The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods -A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results -The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion -The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

What’s New in Infection on Surgical Site and Antibioticoprophylaxis in Surgery?

“…Ferraz et al 18 studied the continuous infusion of cefazolin vs. ampicillin/sulbactam and ertapenem in bariatric patients, and evaluated their effects on the incidence of surgical site infection. The infection rate was analyzed, as well as its association with age, gender, preoperative weight, body mass index and comorbidities, noting that the SSI rates were 4.16% in the group prophylactically treated with ampicillin/sulbactam, 1.98% for ertapenem and 1.55% for continuous cefazolin.…”

Single Dose Based Ertapenem Prophylaxis Reduces Surgical Site Infection after Selective Hepatectomy of Hepatocellular Carcinoma: A Propensity Score Matching Study

“…As reported, the same ertapenem dosage can be administrated, independent of gender, age, weight, or liver disease [ 24 ]. A prospective study assessed the efficacy of ertapenem in preventing infection after weight loss surgery and revealed that the incidence of postoperative infection did not increase among patients who received a single dose (1 g) of ertapenem injection before surgery, when compared with patients who received a preoperative injection of cefazolin (2 g) combined with intraoperative cefazolin (1 g) or with the preoperative administration of ampicillin (2 g)/sulbactam (1 g) [ 25 ]. As reported, the SSI rates in the ER group, ampicillin/sulbactam group, and continuous cefazolin group were 1.98%, 4.12%, and 1.50%, respectively.…”

Fatores associados ao tabagismo em pacientes pós-cirurgia bariátrica

“…Se utilizó la prueba cui-cuadrado con el valor de p<0,05. Resultados: Se encontró 50 pacientes (16,5%;IC95% 12,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)8) con el consumo de tabaco en los últimos 30 días. Se asociaron como factores al consumo dependiente del cigarro: el sexo (p<0,003), el diagnóstico de ansiedad (p<0,008), el histórico familiar de suicidio (p<0,013) las dificultades de dormir (p<0,007) y el uso excesivo de alcohol (p<0,045) con asociación negativa para la práctica religiosa (p>0,038).…”

“…Nesse contexto, a cirurgia bariátrica (CB) atua como uma estratégia de redução de peso corporal nos indivíduos obesos mórbidos (5) . No Brasil, houve um crescimento indiscriminado do número de procedimentos cirúrgicos entre os anos de 2012 a 2015, passando de 72 mil procedimentos, em 2016, para mais de 93 mil, em 2017 (6) .…”

“…A média de idade da população investigada é 37,22 anos (desvio padrão -DP de 9,78;IC95% 36,32), com média de 22,51 meses pós-cirúrgico (DP de 24,77; IC95% 19,68-25,49). A prevalência de fumantes nos últimos 30 dias representou 50 pacientes(16,5%; IC95% 12,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)8). A Tabela I apresenta os fatores associados.Tabela I -Prevalência e fatores associados ao tabagista atual em pacientes pós-cirurgia bariátrica.…”