Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands,
Int J Clin Pharm. 2013 Oct;35(5):798-804. doi: 10.1007/s11096-013-9810-z. Epub 2013 Jun 21.
Patients with coronary artery bypass graft (CABG) surgery are at risk for severe postoperative infections. Prophylactic cefuroxime may help to reduce this risk, however sufficient concentrations, i.e. above the breakpoint (32 mg/L), are mandatory. The aim of this study is to evaluate the blood concentrations of cefuroxime during and after CABG surgery with cardiopulmonary bypass (CPB) and hypothermia, to determine the concentration of cefuroxime in sternum fluid and to evaluate possible factors of influence.
Seventeen patients were enrolled in this study, given 1.5 g cefuroxime at anaesthesia induction and an additional 1.5 g at start CPB. Blood samples were collected at skin incision, start CPB, every 30 min on CPB, end CPB, at wound closure and 1 h after surgery. Cefuroxime concentrations were determined by high performance liquid chromatography.
In 47 % of the patients the cefuroxime concentration was below the breakpoint at some point during the operation and in 59 % of the patients 1 h after surgery. A statistically significant inverse correlation between estimated glomerular filtration rate and plasma cefuroxime concentrations was found (P = 0.034). Cefuroxime levels in the sternum are not significantly different from blood levels from the radial artery catheter, taken at approximately the same time (P = 0.30).
The current antibiotic regimen used did not maintain cefuroxime concentrations above the breakpoint throughout the operation, suggesting insufficient antibiotic prophylaxis. Further research to other antibiotic regimes is therefore necessary.
冠状动脉旁路移植术（CABG）患者有发生严重术后感染的风险。预防性使用头孢呋辛可能有助于降低这种风险，然而，需要维持足够的浓度，即高于折点（32mg/L）。本研究旨在评估体外循环（CPB）和低温下 CABG 手术期间和之后头孢呋辛的血液浓度，确定胸骨液中的头孢呋辛浓度，并评估可能的影响因素。
本研究纳入了 17 名患者，在麻醉诱导时给予 1.5g 头孢呋辛，在 CPB 开始时给予另外 1.5g。在皮肤切开时、CPB 开始时、CPB 每 30 分钟、CPB 结束时、伤口关闭时和手术后 1 小时采集血样。通过高效液相色谱法测定头孢呋辛浓度。
在 47%的患者中，在手术过程中的某个时刻，头孢呋辛浓度低于折点，在 59%的患者中，在手术后 1 小时时浓度低于折点。估计肾小球滤过率与血浆头孢呋辛浓度呈显著负相关（P=0.034）。胸骨内的头孢呋辛水平与桡动脉导管内的血液水平（大约在同一时间采集）无显著差异（P=0.30）。
目前使用的抗生素方案在整个手术过程中未能维持头孢呋辛浓度高于折点，提示抗生素预防不足。因此，需要进一步研究其他抗生素方案。
