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Plasma and myocardial levels of cefonicid during open-heart surgery
Abstract:
To minimize the incidence of postoperative infections in patients undergoing open-heart surgery, antibiotics should maintain tissue concentrations greater than the minimal inhibitory concentration (MIC) for potential pathogens (eg, Staphylococcus) for the duration of the operation. The ability of cefonicid, a new β-lactamase-resistant parenteral cephalosporin, to attain plasma and myocardial levels greater than the MIC (4.8 to 5.0 μg/mL) for penicillin-resistant Staphylococci was assessed in 13 patients. Six patients were administered 1 g and seven patients were administered 2 g of cefonicid IM one hour prior to surgery. In all patients the plasma concentrations of the drug were determined at the start of surgery, 15 minutes after the patient was placed on cardiopulmonary bypass (CPB), and at the completion of CPB. In addition, the concentration of cefonicid was determined in a right atrial biopsy. It was found that both 1 g and 2 g of cefonicid administered one hour prior to surgery resulted in plasma and myocardial levels greater than the MIC for the organisms most frequently implicated in postoperative infections.
Insights
Cefonicid antibiotic levels in patients undergoing open-heart surgery exceeded the minimal inhibitory concentration (MIC) for Staphylococcus. Both 1g and 2g doses achieved effective plasma and myocardial concentrations, crucial for preventing postoperative infections.
Area of Science:
- Pharmacology
- Cardiovascular Surgery
- Infectious Disease
Background:
- Postoperative infections are a risk in open-heart surgery.
- Maintaining antibiotic tissue concentrations above the minimal inhibitory concentration (MIC) is vital.
- Staphylococcus is a common pathogen in these infections.
Purpose of the Study:
- To assess cefonicid's ability to achieve therapeutic levels in plasma and myocardial tissue.
- To determine if cefonicid concentrations remain above the MIC for penicillin-resistant Staphylococci during surgery.
- To evaluate cefonicid as a prophylactic antibiotic in open-heart surgery.
Main Methods:
- 13 patients undergoing open-heart surgery were studied.
- Cefonicid was administered intramuscularly (1g or 2g) one hour pre-surgery.
- Plasma and right atrial biopsy concentrations were measured at key surgical time points.
Main Results:
- Both 1g and 2g doses of cefonicid achieved plasma and myocardial concentrations above the MIC (4.8-5.0 μg/mL).
- Therapeutic drug levels were maintained throughout the surgical procedure.
- Cefonicid demonstrated effective penetration into myocardial tissue.
Conclusions:
- Cefonicid effectively achieves and maintains plasma and myocardial concentrations above the MIC for relevant pathogens.
- Cefonicid is a promising parenteral cephalosporin for preventing postoperative infections in open-heart surgery.
- Preoperative intramuscular cefonicid administration is a viable strategy for surgical prophylaxis.