Effect of Body Mass Index and Ertapenem versus Cefotetan Prophylaxis on Surgical Site Infection in Elective Colorectal Surgery

Itani, Kamal M.F.; Jensen, Erin; Finn, Tyler S.; Tomassini, Joanne E.; Abramson, Murray A.

doi:10.1089/sur.2007.034

Cited by 49 publications

(24 citation statements)

References 23 publications

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“…Obese patients receiving the same dose of cefotetan preoperatively as non-obese patients have higher rates of SSI [86], whereas obese patients receiving higher doses of cephazolin (2 vs. 1 g) had lower rates of perioperative wound infection (5.6 vs. 16.5%) [81]. Obese patients receiving the same dose of cefotetan preoperatively as non-obese patients have higher rates of SSI [86], whereas obese patients receiving higher doses of cephazolin (2 vs. 1 g) had lower rates of perioperative wound infection (5.6 vs. 16.5%) [81].…”

Section: Cephalosporinsmentioning

confidence: 99%

Dosing of antibiotics in obesity

Janson¹,

Thursky

2012

Current Opinion in Infectious Diseases

138

120

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Obesity causes a number of changes, including an increase in volume of distribution and changes in hepatic metabolism and renal excretion. Several antibiotics have sufficient data to be able to make recommendations, whereas other antibiotics may need to make use of doses at the upper end of the recommended range, or utilize other dose modifications based on pharmacokinetic/pharmacodynamic parameters, in an attempt to reach adequate levels and achieve similar efficacy.

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Section: Cephalosporinsmentioning

confidence: 99%

Dosing of antibiotics in obesity

Janson¹,

Thursky

2012

Current Opinion in Infectious Diseases

138

120

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“…In particular, cefuroxime, a secondgeneration cephalosporin, has been successfully used in surgery units [4]. However, it has been shown that obese patients are at a higher risk of developing SSI compared with normal weight subjects [7,8]. Due to the high prevalence of obesity (at least 400 million adults worldwide [9]), free, active antibiotic concentrations at the site of infection following a standard dose should be evaluated in this population.…”

Section: Introductionmentioning

confidence: 99%

Soft tissue penetration of cefuroxime determined by clinical microdialysis in morbidly obese patients undergoing abdominal surgery

Barbour

Schmidt

Rout

et al. 2009

International Journal of Antimicrobial Agents

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“…As for the high rate of superficial-site infection observed in the study by Itani and colleagues (22.4% in cefotetan group and 13.1% in ertapenem group), it should be noted that 28.9% of the patients evaluated had a body mass index (BMI) ±30 kg/m 2 , which is much higher of the rates of obese patients usually included in other studies 82,83,86. Furthermore, in a post-hoc analysis performed using the data from the study by Itani and colleagues, the incidence of SSIs, and specifically of superficial incisional SSIs, was found to be higher in patients with a BMI ± 30 kg/m 2 regardless of the prophylactic antibiotic (ertapenem or cefotetan) given 87. Indeed, failure of antibiotic surgical prophylaxis in obese patients may be related both to technical factors, such as an inadequate obliteration of “dead spaces,” and to low drug levels in serum and tissues, especially at the end of an operation and during surgery 88.…”

Section: Discussionmentioning

confidence: 75%

Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

Lalla¹

2009

TCRM

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Despite improvement in infection control measures and surgical practice, surgical site infections (SSIs) remain a major cause of morbidity and mortality. In colorectal surgery, perioperative administration of a suitable antimicrobial regimen that covers both anaerobic and aerobic bacteria is universally accepted. In a prospective, double-blind, randomized study ertapenem was recently found to be more effective than cefotetan, a parenteral cephalosporin so broadly used as to be considered as gold standard in the prevention of SSIs following colorectal surgery. In this adequate and well controlled study, the superiority of ertapenem over cefotetan was clearly demonstrated from the clinical and bacteriological points of view. However, data that directly compares ertapenem with other antimicrobial regimen effective in preventing SSIs following colorectal surgery are lacking; furthermore, the possible risk of promotion of carbapenem resistance associated with widespread use of ertapenem prophylaxis as well as the ertapenem effects on the intestinal gut flora are of concern. Further comparative studies of ertapenem versus other widely used prophylactic regimens for colorectal surgery in patients submitted to mechanical bowel preparation versus no preparation as well as further research on adverse events of antibiotic prophylaxis, including emergence of resistance and Clostridium difficile infection, seem warranted.

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Effect of Body Mass Index and Ertapenem versus Cefotetan Prophylaxis on Surgical Site Infection in Elective Colorectal Surgery

Cited by 49 publications

References 23 publications

Dosing of antibiotics in obesity

Dosing of antibiotics in obesity

Soft tissue penetration of cefuroxime determined by clinical microdialysis in morbidly obese patients undergoing abdominal surgery

Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

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