Selection of Prophylactic Antimicrobial Agent May Affect Incidence of Infection in Small Bowel and Colorectal Surgery

Eagye, Kathryn J.; Nicolau, David P.

doi:10.1089/sur.2010.108

Cited by 12 publications

(9 citation statements)

References 21 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be due to an increasing number of studies in which ertapenem compares favorably to other antibiotics in SSI prevention. 5,10,18,19 One of the main drivers in particular may have been the highly publicized 2006 trial by Itani et al which showed ertapenem to be more effective than cefotetan in the prevention of SSIs in patients undergoing elective open colorectal surgery. 10 In addition, ertapenem covers both anaerobes and aerobes found in bowel lumen, has a relatively long half-life (preventing the need for a second administration), and a similar safety profile compared to other prophylaxis choices.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Open Colectomies

Poeran

Wasserman

Zubizarreta

et al. 2016

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

Background Despite numerous trials assessing optimal antibiotic prophylaxis strategies for colorectal surgery, few studies have assessed real-world practice on a national scale with respect to risk of surgical site infections. Objective Using a large, national claims database we aimed to describe 1) current use of prophylactic antibiotics (type and duration) and 2) associations with surgical site infection after open colectomies. Design Retrospective study using the Premier Perspective database. Setting Patient hospitalizations nationwide from January 2006 to December 2013. Patients 90,725 patients that underwent an open colectomy in 445 different hospitals. Main Outcome Measures Multilevel multivariable logistic regressions measured associations between surgical site infection and 1) type of antibiotic used and 2) duration (day of surgery only, day of surgery and the day after, >1 day after surgery). Results Overall surgical site infection prevalence was 5.2% (n=4,750). Most patients (41.8%) received cefoxitin for prophylaxis; other choices were ertapenem (18.2%), cefotetan (10.3%), metronidazole+cefazolin (9.9%), ampicillin+sulbactam (7.6%), while 12.2% received other antibiotics. Distribution of prophylaxis duration was: 51.6%, 28.5%, and 19.9% for days 0, 0+1, and 1+, respectively. Compared to cefoxitin, lower odds for surgical site infection were observed for ampicillin+sulbactam (odds ratio 0.71; 95% confidence interval 0.63–0.82), ertapenem (odds ratio 0.65; 95% confidence interval 0.58–0.71) and metronidazole+cefazolin (odds ratio 0.56; 95% confidence interval 0.49–0.64), and “other” (odds ratio 0.81; 95% confidence interval 0.73–0.90); duration was not significantly associated with altered odds for surgical site infection. Sensitivity analyses supported the main findings. Limitations Lack of detailed clinical information in the billing dataset used. Conclusions In this national study assessing real-world use of prophylactic antibiotics in open colectomies, type of antibiotic used appeared to be associated with up to 44% decreased odds for surgical site infections. While there are numerous trials on optimal prophylactic strategies, studies that particularly focus on factors that influence the choice of prophylactic antibiotic might provide insights into ways of reducing the burden of surgical site infections in colorectal surgeries.

show abstract

Section: Discussionmentioning

confidence: 99%

Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Open Colectomies

Poeran

Wasserman

Zubizarreta

et al. 2016

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

show abstract

“…These properties may be associated with reduced SSIs compared to those obtained with other pharmacodynamically less potent antibiotics, which may be more adversely effected by extremes of body weights (46)(47)(48). Appropriate antibiotic selection and appropriate dosing are both important for achieving optimal outcomes related to surgical prophylaxis (49,50); currently recommended cefoxitin regimens may not be optimal in either respect.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic and Pharmacodynamic Evaluation of a Weight-Based Dosing Regimen of Cefoxitin for Perioperative Surgical Prophylaxis in Obese and Morbidly Obese Patients

Moine

Mueller

Schoen

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The objective of this study was to determine the pharmacokinetics and pharmacodynamics (PK/PD) of a weight-based cefoxitin dosing regimen for surgical prophylaxis in obese patients. Patients received a single dose of cefoxitin at 40 mg/kg based on total body weight. Cefoxitin samples were obtained over 3 h from serum and adipose tissue, and concentrations were determined by validated high-performance liquid chromatography. Noncompartmental pharmacokinetic analysis was performed, followed by Monte Carlo simulations to estimate probability of target attainment (PTA) for Staphylococcus aureus, Escherichia coli, and Bacteroides fragilis over 4-h periods postdose. Thirty patients undergoing bariatric procedures were enrolled. The body mass index (mean ؎ standard deviation [SD])was 45.9 ؎ 8.0 kg/m 2 (range, 35.0 to 76.7 kg/m 2 ); the median cefoxitin dose was 5 g (range, 4.0 to 7.5 g). The mean maximum concentrations were 216.15 ؎ 41.80 g/ml in serum and 12.62 ؎ 5.89 in tissue; the mean tissue/serum ratio was 8% ؎ 3%. In serum, weight-based regimens achieved >90% PTA (goal time during which free [unbound] drug concentrations exceed pathogen MICs [fT>MIC] of 100%) for E. coli and S. aureus over 2 h and for B. fragilis over 1 h; in tissue this regimen failed to achieve goal PTA at any time point. The 40-mg/kg regimens achieved higher PTAs over longer periods in both serum and tissue than did the standard 2-g doses. However, although weight-based cefoxitin regimens were better than fixed doses, achievement of desired pharmacodynamic targets was suboptimal in both serum and tissue. Alternative dosing regimens and agents should be explored in order to achieve more favorable antibiotic performance during surgical prophylaxis in obese patients. Surgical site infections (SSIs) are the leading cause of postoperative morbidity and mortality and add significantly to the cost of care (1). Perioperative antibiotic prophylaxis is therefore a standard of care and a keystone for the prevention of SSIs (2-6). Recommendations regarding the use of specific antibiotics for prophylaxis during surgical procedures have been published since the early 1990s and have been frequently revisited since that time (1, 2, 5-9). More recently, specific recommendations provided by the National Surgical Infection Prevention (SIP) Project have focused on appropriate timing of administration of prophylactic antibiotics, appropriate drug selection, and the discontinuation of prophylactic antibiotics within 24 h after surgery (2, 9). However, the actual recommended drugs and dosing regimens for surgical prophylaxis have been relatively unchanged over the past 20 years. Limited published data exist regarding appropriate dosing of antimicrobials for prophylaxis. It is generally stated that the drug should be given in an adequate dose based on patient weight, adjusted dosing weight, or body mass index (BMI) (2, 6, 9). Furthermore, antibiotic administration should be repeated intraoperatively if the procedure continues beyond one to two pharmacokinetic (PK) hal...

show abstract

“…Whereas Staphylococcus aureus is the most common pathogen responsible for SSIs after clean surgery, the majority of SSIs after colorectal interventions are caused by the aerobic and anaerobic commensal flora of the colon [1][2][3]. Regimens for peri-operative antibiotic prophylaxis in colorectal surgery do not cover methicillin-resistant S. aureus (MRSA) and offer various degrees of coverage for methicillin-sensitive S. aureus and other gram-positive pathogens [4]. Even if the relative frequency of S. aureus as the cause of SSI in colorectal surgery is low, it might still be responsible for a substantial number of SSIs, as the overall rate of SSI is much higher after colorectal surgery than after other types of surgery, but this has been investigated rarely [5].…”

mentioning

confidence: 99%

Epidemiology of Methicillin-Resistant Staphylococcus aureus Carriage and MRSA Surgical Site Infections in Patients Undergoing Colorectal Surgery: A Cohort Study in Two Centers

Huttner

Robicsek

Gervaz³

et al. 2012

Surgical Infections

View full text Add to dashboard Cite

show abstract

Selection of Prophylactic Antimicrobial Agent May Affect Incidence of Infection in Small Bowel and Colorectal Surgery

Abstract: Agent selection among prophylactic antibiotics is one of many factors associated with infection development in colorectal surgery patients.

Cited by 12 publications

References 21 publications

Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Open Colectomies

Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Open Colectomies

Pharmacokinetic and Pharmacodynamic Evaluation of a Weight-Based Dosing Regimen of Cefoxitin for Perioperative Surgical Prophylaxis in Obese and Morbidly Obese Patients

Epidemiology of Methicillin-Resistant Staphylococcus aureus Carriage and MRSA Surgical Site Infections in Patients Undergoing Colorectal Surgery: A Cohort Study in Two Centers

Contact Info

Product

Resources

About