Intraoperative Redosing of Cefazolin
Intraoperative Redosing of Cefazolin
Intraoperative redosing of prophylactic antibiotics is recommended for prolonged surgical procedures, although its efficacy has not been assessed. We retrospectively compared the risk of surgical site infections in 1,548 patients who underwent cardiac surgery lasting >240 min after preoperative administration of cefazolin prophylaxis. The overall risk of surgical site infection was similar among patients with (43 [9.4%] of 459) and without (101 [9.3%] of 1,089) intraoperative redosing (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.70-1.47). However, redosing was beneficial in procedures lasting >400 min: infection occurred in 14 (7.7%) of 182 patients with redosing and in 32 (16.0%) of 200 patients without (adjusted OR 0.44, 95% CI 0.23-0.86). Intraoperative redosing of cefazolin was associated with a 16% reduction in the overall risk for surgical site infection after cardiac surgery, including procedures lasting <240 min.
Surgical site infections are important causes of illness and resource utilization. Perioperative antibiotic prophylaxis is widely used to reduce their incidence. On the basis of pharmacokinetic considerations, most published guidelines recommend intraoperative redosing of the prophylactic antibiotic for procedures of prolonged duration to maintain effective antibiotic concentrations.
Support for intraoperative redosing of antibiotics has been inferred from observational studies in which increased duration of surgery was associated with increased risk for surgical site infection, as well as loss of the protective effect of prophylaxis over time. However, the actual clinical benefit of intraoperative antibiotic redosing has not been confirmed or quantified in either clinical trials or observational studies.
We therefore carried out a retrospective cohort study to assess the effect of intraoperative redosing of prophylaxis on the occurrence of surgical site infection after prolonged cardiac procedures. Cardiac surgery was chosen for the study because its duration is typically long enough to meet the threshold for redosing in most published guidelines and because it carries a substantial risk for surgical site infection.
Intraoperative redosing of prophylactic antibiotics is recommended for prolonged surgical procedures, although its efficacy has not been assessed. We retrospectively compared the risk of surgical site infections in 1,548 patients who underwent cardiac surgery lasting >240 min after preoperative administration of cefazolin prophylaxis. The overall risk of surgical site infection was similar among patients with (43 [9.4%] of 459) and without (101 [9.3%] of 1,089) intraoperative redosing (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.70-1.47). However, redosing was beneficial in procedures lasting >400 min: infection occurred in 14 (7.7%) of 182 patients with redosing and in 32 (16.0%) of 200 patients without (adjusted OR 0.44, 95% CI 0.23-0.86). Intraoperative redosing of cefazolin was associated with a 16% reduction in the overall risk for surgical site infection after cardiac surgery, including procedures lasting <240 min.
Surgical site infections are important causes of illness and resource utilization. Perioperative antibiotic prophylaxis is widely used to reduce their incidence. On the basis of pharmacokinetic considerations, most published guidelines recommend intraoperative redosing of the prophylactic antibiotic for procedures of prolonged duration to maintain effective antibiotic concentrations.
Support for intraoperative redosing of antibiotics has been inferred from observational studies in which increased duration of surgery was associated with increased risk for surgical site infection, as well as loss of the protective effect of prophylaxis over time. However, the actual clinical benefit of intraoperative antibiotic redosing has not been confirmed or quantified in either clinical trials or observational studies.
We therefore carried out a retrospective cohort study to assess the effect of intraoperative redosing of prophylaxis on the occurrence of surgical site infection after prolonged cardiac procedures. Cardiac surgery was chosen for the study because its duration is typically long enough to meet the threshold for redosing in most published guidelines and because it carries a substantial risk for surgical site infection.
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