[Antibiotic concentration during extracorporeal circulation (author's transl)]

Area of Science:

• Pharmacology
• Surgical Antibiotic Prophylaxis

Context:

• Open surgery necessitates effective antibiotic prophylaxis to prevent infections.
• Extracorporeal circulation (ECC) presents unique challenges for maintaining therapeutic drug levels.
• Accurate antibiotic dosing is crucial during ECC to ensure patient safety and treatment efficacy.

Purpose:

• To compare the variability of antibiotic blood concentrations between two dosing strategies during open surgery with ECC.
• To determine optimal antibiotic blood concentration targets during ECC, particularly for patients with subacute bacterial endocarditis.

Summary:

• Two groups received antibiotics: Group A (standard dose) and Group B (weight- and priming volume-adjusted dose).
• Group A exhibited highly variable blood antibiotic concentrations, complicating dosage adjustments.
• Group B demonstrated more consistent antibiotic levels, facilitating better management during ECC.
• Maintaining blood antibiotic concentrations at 50 µg/ml is recommended during prolonged ECC, with additional doses 90-120 minutes post-initiation.
• For patients with preoperative subacute bacterial endocarditis, concentrations above 100 µg/ml are advised during ECC.

Impact:

• Findings suggest that a calculated antibiotic dosing strategy (Group B) is superior for maintaining stable therapeutic levels during ECC.
• The study provides evidence-based recommendations for antibiotic administration timing and target concentrations in surgical patients undergoing ECC.
• This research can inform clinical guidelines for antibiotic prophylaxis in complex surgical procedures, potentially reducing surgical site infections and improving patient outcomes.