Serum cefazolin levels during cardiopulmonary bypass

Area of Science:

• Pharmacology
• Cardiovascular Surgery
• Infectious Disease Prevention

Background:

• Prophylactic antibiotic selection is crucial in preventing surgical site infections during open-heart operations.
• Cefazolin is a commonly used antibiotic, but its efficacy during cardiopulmonary bypass requires specific assessment.
• Maintaining adequate antibiotic serum concentrations is vital for perioperative infection control.

Purpose of the Study:

• To evaluate the adequacy and stability of serum cefazolin levels in adult and pediatric patients undergoing open-heart surgery with cardiopulmonary bypass.
• To determine if a single intramuscular dose of cefazolin is sufficient for perioperative prophylaxis in this patient population.

Main Methods:

• Adult patients received 1 gm of cefazolin intramuscularly; pediatric patients received 20 mg/kg.
• Serum cefazolin levels were measured after the institution of cardiopulmonary bypass in both groups.
• Patients underwent various cardiac procedures, including repair of congenital anomalies.

Main Results:

• Mean serum cefazolin level in adults was 27.36 µg/ml (range: 13.1–40.3 µg/ml) and remained stable.
• Mean serum cefazolin level in pediatric patients was 20.01 µg/ml (range: 11.4–28.9 µg/ml) and remained stable.
• Perfusion pressure, urinary output, and body temperature did not significantly affect cefazolin levels.

Conclusions:

• A single preoperative intramuscular dose of cefazolin achieves adequate and stable serum concentrations during cardiopulmonary bypass for up to three hours.
• This regimen is considered effective for antibiotic prophylaxis in patients undergoing open-heart surgery.
• The findings support the use of cefazolin as a reliable prophylactic agent in cardiac surgical procedures.