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Perioperative Cefazolin Prophylaxis in Pediatric Cardiac Surgery: A Prospective, Cohort Study
Jessica Suna1, Gregory Moloney2, Supreet P Marathe3
1University of Queensland, Brisbane, Australia; Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia.
Insights
Pediatric cardiac surgery patients achieved target cefazolin levels during surgery. However, older, larger children were less likely to maintain adequate cefazolin concentrations post-operatively, indicating insufficient dosing.
Area of Science:
- Pharmacology
- Pediatric Cardiac Surgery
- Antibiotic Dosing
Background:
- Cardiac surgeries in children often require antibiotic prophylaxis.
- Cefazolin is a commonly used antibiotic in these procedures.
- Understanding factors affecting cefazolin levels is crucial for effective treatment.
Purpose of the Study:
- To investigate the impact of age, prolonged bypass, and hypothermia on serum cefazolin concentrations in pediatric cardiac surgery patients.
- To assess the adequacy of cefazolin dosing strategies in this population.
Main Methods:
- Prospective, single-center observational study.
- Collected blood samples from pediatric patients undergoing cardiac surgery at multiple intraoperative and postoperative time points.
- Measured serum cefazolin concentrations, targeting unbound concentrations of 2 mg/L.
Main Results:
- All patients maintained target cefazolin concentrations intraoperatively.
- Older and larger children were significantly less likely to achieve target unbound serum cefazolin concentrations postoperatively (P < .0001).
- 30% of patients did not maintain target concentrations in the first 24 hours after surgery.
Conclusions:
- Intraoperative cefazolin dosing achieved target concentrations in all pediatric cardiac surgery cases.
- Postoperative cefazolin dosing appears insufficient to maintain therapeutic concentrations in many pediatric patients.
- Age and body size are significant factors influencing cefazolin pharmacokinetics in this population.
Background:
This study's objective was to determine the effect of age, prolonged bypass, and hypothermia on serum cefazolin concentrations in children undergoing cardiac surgery.
Methods:
A prospective, single-center, observational study was conducted, examining children undergoing cardiac surgery. Participants received cefazolin intravenously approximately 1 hour before skin incision, 3 hourly intraoperatively, and 8 hourly postoperatively. Blood samples were collected at 6 to 8 time points intraoperatively and at 6 time points in the first 24 hours postoperatively. Target unbound serum cefazolin concentrations were 2 mg/L.
Results:
Sixty-eight patients were enrolled in the study, and 64 were included in the analysis. All maintained concentrations ≥ 2 mg/L throughout the operation. Nineteen patients (30%) did not maintain concentrations ≥ 2 mg/L in the first 24 hours after surgery. Older, larger children (P < .0001) were significantly less likely to achieve target unbound serum cefazolin concentrations.
Conclusions:
Intraoperative cefazolin concentrations reached the target concentration in all pediatric cardiac surgical cases. Postoperative cefazolin dosing appears to be insufficient to achieve minimum inhibitory concentrations in many patients.
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