JAC Advance Access originally published online on May 15, 2007
Journal of Antimicrobial Chemotherapy 2007 60(1):166-169; doi:10.1093/jac/dkm128
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Inadequate antimicrobial prophylaxis during surgery: a study of ß-lactam levels during burn debridement
1 Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia 2 Therapeutics Research Unit, School of Medicine, University of Queensland, Brisbane, Queensland, Australia 3 Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia 4 Department of Intensive Care Medicine, Princess Alexandra and Wesley Hospitals, Brisbane, Queensland, Australia 5 Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Received 13 February 2007; returned 11 March 2007; revised 28 March 2007; accepted 5 April 2007
* Correspondence address. Therapeutics Research Unit, School of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland 4102, Australia. Tel: +61-7-3240-5364; Fax: +61-7-3240-5806; E-mail: s.cross{at}uq.edu.au
Objectives: To determine how long single-dose prophylactic antibiotic regimens for burns surgery maintained plasma concentrations above the MICs for target organisms during surgery.
Patients and methods: We monitored antibiotic plasma concentrations in 12 patients (mean ± SD 43 ± 12% total burn surface area) throughout debridement surgery after administration of the standard prophylactic antibiotic dosing regimens of either 1 g of intravenous cefalotin or 4.5 g of intravenous piperacillin/tazobactam.
Results: The eschar debridement and grafting procedures ranged in duration from 2.25 to over 8.5 h. The duration of total plasma cefalotin concentration above an MIC of 0.2 mg/L for Staphylococcus aureus was 6.49 ± 2.85 h, whereas the mean duration of total plasma piperacillin concentration above an MIC of 64 mg/L for Pseudomonas aeruginosa was only 1.15 ± 0.59 h. None of the patients dosed with piperacillin/tazobactam was adequately protected for the duration of their surgery and adequate prophylaxis was only evident in four of the nine patients administered cefalotin.
Conclusions: These results suggest a need to review antibiotic prophylaxis dosage regimens for burns surgery and the adoption of regimens that will minimize the risk of infection in this high-risk patient group. It is suggested that the antibiotic prophylaxis guideline for burn debridement surgery be modified to include re-dosing or a continuous infusion of ß-lactam antibiotics.
Keywords: antibiotic prophylaxis , intraoperative period , drug administration schedule , adult burns
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