Cefuroxime Plasma and Tissue concentrations in Patients Undergoing Elective Cardiac Surgery: Continuous versus Bolus Application A Pilot Study

Abstract

Aim

Surgical site infections contribute to morbidity and mortality after surgery. The authors hypothesized that higher antibiotic tissue concentrations can be reached for a prolonged time span by continuous administration of prophylactic cefuroxime compared to bolus administration.

Methods

Twelve patients undergoing elective cardiac surgery were investigated. Group A received 1.5 g cefuroxime as bolus infusions before surgery, and 12 and 24 hours thereafter. In group B, a continuous infusion of 3.0 g cefuroxime was started after a bolus of 1.5 g. Cefuroxim levels were determined in blood and tissue (microdialysis). T‐test, Wilcoxon Signed Rank test, and chi‐square test were used for statistical analysis.

Results

The area under the curve (AUC) of plasma cefuroxime concentrations was greater in group B (399 [333‐518]) as compared to group A (257 [177‐297] h•mg•L^‐1, (median and IQR), P = 0.026). Furthermore, a significantly longer percentage of time > minimal inhibitory concentrations of 2 mg•L^‐1 (100% vs. 50%), 4 mg•L^‐1 (100% vs. 42%), 8 mg•L^‐1 (100% vs. 17%), and 16 mg•L^‐1 (83% vs. 8%) was found for free plasma cefuroxime in group B. In group B AUC in subcutaneous tissue (78 [61‐113] h•mg•L^‐1) and median peak concentration (33 [26‐38] mg•L^‐1) were markedly higher compared to group A (P = 0.041 and P = 0.026, respectively).

Conclusions

Higher cefuroxime concentrations were measured in plasma and subcutaneously over a prolonged period of time when cefuroxime was administered continuously. The clinical implication of this finding still has to be elucidated.

http://bit.ly/2RGlkxz