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Skeletal muscle and plasma concentrations of cefazolin during complex paediatric spinal surgery

A S Himebauch1, W N Sankar2, J M Flynn2

  • 1Department of Anesthesiology and Critical Care Medicine Center for Clinical Pharmacology himebaucha@email.chop.edu.

British Journal of Anaesthesia
|June 19, 2016
PubMed

Insights

Cefazolin dosing for pediatric spinal surgery achieved high concentrations against MSSA but was insufficient for Gram-negative pathogens, indicating potential risks for surgical site infections (SSIs). Further research is needed to optimize prophylaxis.

Area of Science:

  • Pharmacology
  • Pediatric Surgery
  • Infectious Disease

Background:

  • Surgical site infections (SSIs) pose significant risks to pediatric patients undergoing spinal instrumentation.
  • Limited prospective data exist on the efficacy of prophylactic cefazolin in this specific population.
  • Understanding cefazolin's pharmacokinetics and tissue disposition is crucial for optimizing infection prevention.

Purpose of the Study:

  • To evaluate the pharmacokinetics and skeletal muscle disposition of prophylactic cefazolin in children undergoing complex spinal surgery.
  • To determine if standard cefazolin dosing achieves adequate concentrations for surgical site infection (SSI) prophylaxis in pediatric patients.

Main Methods:

  • A prospective pharmacokinetic study involving 17 children with adolescent idiopathic scoliosis undergoing posterior spinal fusion.
  • Serial plasma and skeletal muscle microdialysis samples were collected to measure unbound cefazolin concentrations.
  • Non-compartmental pharmacokinetic analysis was performed to assess drug exposure and time above the minimum inhibitory concentration (MIC).

Main Results:

  • Skeletal muscle cefazolin concentrations peaked rapidly after dosing, reaching median values of 37.6-40.5 µg/mL.
  • Target concentrations for methicillin-sensitive Staphylococcus aureus (MSSA) were exceeded for 98.9% of intraoperative time.
  • Target concentrations for Gram-negative pathogens were only exceeded for 58.3% of intraoperative time.

Conclusions:

  • The standard cefazolin dosing strategy in this pediatric cohort provided adequate intraoperative concentrations against MSSA.
  • However, the achieved skeletal muscle concentrations were likely insufficient for effective prophylaxis against Gram-negative pathogens.
  • Current cefazolin dosing may not fully protect against Gram-negative SSIs in pediatric spinal fusion surgery.
Abstract

Keywords:
cefazolinmicrodialysispaediatricscoliosissurgery, spinal

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