Forse R A, Karam B, MacLean L D, Christou N V
Department of Surgery and Microbiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Surgery. 1989 Oct;106(4):750-6; discussion 756-7.
The rate of wound infections in morbidly obese patients who underwent gastroplasty surgery at our institution was 16.5% compared with a rate of 2.5% in normal-weight patients who underwent clean-contaminated surgery. Both groups received 1 gm of cefazolin intramuscularly before surgery was performed. We hypothesized that this regimen of prophylaxis did not provide adequate tissue levels in the morbidly obese. Morbidly obese patients who were undergoing gastroplasty were randomly selected to receive 1 gm cefazolin in the buttock fat, buttock muscle, or by intravenous injection. A fourth group of morbidly obese patients received 2 gm of cefazolin intravenously. Normal-weight patients who were undergoing upper abdominal surgery received 1 gm of cefazolin intravenously. At incision and closure, both blood and tissue levels of cefazolin were significantly (p less than 0.001) lower for all morbidly obese patients who received 1 gm cefazolin when compared with the blood and tissue levels of the drug found in normal-weight patients. The cefazolin levels obtained were below the minimal inhibitory concentrations of greater than 2 micrograms/ml for gram-positive cocci and of greater than 4 micrograms/ml for gram-negative rods. Only when the morbidly obese patient received 2 gm cefazolin were both the serum and adipose tissue levels adequate. For a 4-month period, all morbidly obese patients received 2 gm cefazolin prophylaxis, and the wound infection rate dropped to 5.6% compared with the previous rate of 16.5% (p less than 0.03). We conclude that antibiotic prophylaxis must be specially tailored to the needs of these obese patients.
在我们机构接受胃成形术的病态肥胖患者中，伤口感染率为16.5%，而接受清洁-污染手术的正常体重患者的感染率为2.5%。两组患者在手术前均接受了1克头孢唑林肌肉注射。我们推测，这种预防方案在病态肥胖患者中未能提供足够的组织药物浓度。随机选择接受胃成形术的病态肥胖患者，分别在臀肌、臀脂肪或静脉注射1克头孢唑林。第四组病态肥胖患者静脉注射2克头孢唑林。接受上腹部手术的正常体重患者静脉注射1克头孢唑林。在切开和缝合时，所有接受1克头孢唑林的病态肥胖患者的头孢唑林血液和组织浓度均显著低于（p<0.001）正常体重患者的药物血液和组织浓度。所测得的头孢唑林浓度低于革兰氏阳性球菌大于2微克/毫升、革兰氏阴性杆菌大于4微克/毫升的最低抑菌浓度。只有当病态肥胖患者接受2克头孢唑林时，血清和脂肪组织中的药物浓度才足够。在4个月的时间里，所有病态肥胖患者均接受2克头孢唑林预防，伤口感染率降至5.6%，而之前为16.5%（p<0.03）。我们得出结论，抗生素预防必须根据这些肥胖患者的需求进行特殊调整。
