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Influence of intraoperative fluid replacement on ampicillin serum levels and surgical site infections
Irina Staib-Lasarzik1, Sophie Lehr1, Ann Kristin Rosner1
1Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Background:
Surgical site infections (SSI) occur despite antimicrobial prophylaxis and increase postoperative morbidity and mortality. This could be caused by an intraoperative decrease in antibiotic serum concentrations such as ampicillin after major abdominal surgery due to blood loss and fluid therapy, which possibly promotes SSI. This hypothesis was tested in the present study.
Methods:
This pilot study was performed as a prospective observational trial between March 2018 and May 2019. Ampicillin/sulbactam was administered intravenously during anesthesia induction. Fluid replacement was guided based on hemodynamic variables, including analysis of pulse pressure variation. The primary outcome was ampicillin serum level (ASL), measured after administration and hourly within 4 hours. The incidence of SSI at hospital discharge was the secondary outcome. Linear mixed and logistic regression models were used for statistical analyses.
Results:
After screening of 133 adult patients, 129 were enrolled, and 102 completed the study protocol. No correlation was found between the volume of intraoperative fluids and ASL, nor was any association found between ASL and SSI. Based on 5 SSI cases, SSI were associated with higher intraoperative fluid volume. ASL was sufficient to provide intraoperative coverage for all potential bacterial strains.
Conclusion:
Intraoperative fluid replacement had no effect on ASL up to 4 hours after ampicillin/sulbactam administration. SSI were within an acceptable range, indicating adequate antimicrobial prophylaxis, so intraoperative control of ASL does not seem necessary. In conclusion, contrary to our initial hypothesis, ASL is not influenced by volume turnover or blood loss during major surgery and therefore does not affect SSI.
Insights
Intraoperative fluid therapy does not impact ampicillin serum levels (ASL) during major abdominal surgery. This suggests current antimicrobial prophylaxis effectively prevents surgical site infections (SSI).
Area of Science:
- Surgical infections
- Pharmacokinetics
- Anesthesiology
Background:
- Surgical site infections (SSI) are a significant complication despite antibiotic prophylaxis.
- Intraoperative factors like fluid therapy may reduce antibiotic serum concentrations, potentially increasing SSI risk.
Purpose of the Study:
- To investigate the impact of intraoperative fluid replacement on ampicillin serum levels (ASL) after major abdominal surgery.
- To determine if ASL influences the incidence of surgical site infections (SSI).
Main Methods:
- Prospective observational pilot study involving 102 adult patients undergoing major abdominal surgery.
- Ampicillin/sulbactam administered during anesthesia induction; fluid replacement guided by hemodynamic variables.
- ASL measured hourly for 4 hours; SSI incidence recorded at discharge.
Main Results:
- No correlation observed between intraoperative fluid volume and ASL.
- No association found between ASL and SSI incidence.
- SSI cases were associated with higher intraoperative fluid volumes; ASL remained sufficient for bacterial coverage.
Conclusions:
- Intraoperative fluid replacement does not affect ASL within 4 hours post-administration.
- Adequate antimicrobial prophylaxis was indicated by acceptable SSI rates.
- Intraoperative monitoring of ASL is not necessary as it is not influenced by surgical blood loss or fluid turnover.
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