Department of Anesthesiology and Critical Care Medicine, Hôtel Dieu-PTMC, Centre Hospitalo-Universitaire de Nantes, Nantes, France.
Department of Anesthesiology and Critical Care Medicine, Hôtel Dieu-PTMC, Centre Hospitalo-Universitaire de Nantes, Nantes, France; UPRES EA 3826 Laboratory 'Thérapeutiques expérimentales des infections', Faculté de médecine de Nantes, Nantes, France.
Br J Anaesth. 2018 Jun;120(6):1202-1208. doi: 10.1016/j.bja.2017.10.023. Epub 2017 Dec 6.
In obese patients undergoing sleeve gastrectomy, the blood and fatty-tissue concentrations of cefazolin required for adequate antibiotic prophylaxis are uncertain.
This was a single centre prospective study in obese (Group A: 40≤ BMI ≤50 kg m) and severely obese (Group B: 50< BMI ≤65 kg m) patients undergoing bariatric surgery. Blood and fatty-tissue samples were collected after a cefazolin 4 g i.v. injection. The primary aim was to compare cefazolin concentrations in subcutaneous fatty tissue with a targeted tissue concentration of 4 μg g according to Staphylococcus aureus resistance breakpoint.
One hundred and sixteen patients were included: 79 in Group A and 37 in Group B. At the beginning of the surgery, cefazolin concentration in subcutaneous fatty tissue was 12.2 (5.4) μg g in Group A and 12 (6.1) μg g in Group B (P=0.7). At the end, cefazolin concentrations in subcutaneous fatty tissue were 9.0 (4.9) and 7.8 (4.2) μg g in Groups A and B, respectively (P=0.2). The plasma concentration of free cefazolin during surgery was higher in Group A than in Group B (P<0.0001). Fatty-tissue concentrations of 95% and 83% patients in Groups A and B, respectively, were above S. aureus resistance breakpoint.
After a 4 g dose, the concentrations of cefazolin in fatty tissue were above the 4 μg g tissue concentration target, providing adequate antibiotic tissue concentrations during bariatric surgery. As cefazolin concentration in fatty tissue is a surrogate endpoint, the results should be considered in conjunction with the results on free cefazolin concentrations in subcutaneous tissue.
NCT01537380.
在接受袖状胃切除术的肥胖患者中，头孢唑林用于充分抗生素预防的血药浓度和脂肪组织浓度尚不确定。
这是一项在肥胖（A 组：40≤BMI≤50kg/m²）和严重肥胖（B 组：50<BMI≤65kg/m²）患者中进行的单中心前瞻性研究。在静脉注射头孢唑林 4g 后采集血样和脂肪组织样本。主要目的是根据金黄色葡萄球菌耐药性临界点比较皮下脂肪组织中的头孢唑林浓度与目标组织浓度 4μg/g 的差异。
共纳入 116 例患者：A 组 79 例，B 组 37 例。手术开始时，A 组和 B 组的皮下脂肪组织中头孢唑林浓度分别为 12.2（5.4）μg/g 和 12（6.1）μg/g（P=0.7）。手术结束时，A 组和 B 组的皮下脂肪组织中头孢唑林浓度分别为 9.0（4.9）μg/g 和 7.8（4.2）μg/g（P=0.2）。A 组患者术中游离头孢唑林的血浆浓度高于 B 组（P<0.0001）。A 组和 B 组分别有 95%和 83%的患者脂肪组织浓度超过金黄色葡萄球菌耐药临界点。
在给予 4g 剂量后，脂肪组织中的头孢唑林浓度达到了 4μg/g 组织浓度目标，为减肥手术期间提供了足够的抗生素组织浓度。由于脂肪组织中头孢唑林浓度是替代终点，因此应将结果与皮下组织中游离头孢唑林浓度的结果结合起来考虑。
NCT01537380。
