Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1695780
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Early Antibiotic Prophylaxis Prior to Bypass Surgery Improves Tissue Penetration

1  Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Markus Zeitlinger
2  Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Shiva Shabanian
1  Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Wilfried Wisser
1  Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Rainer Thell
3  Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
,
Maximilian Edlinger-Stanger
3  Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
,
Alexandra Maier-Salamon
4  Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
,
Walter Jaeger
4  Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
,
Alfred Kocher
1  Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Guenther Laufer
1  Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Joerg-Michael Hiesmayr
3  Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
,
Doris Hutschala
3  Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

02 June 2019

15 July 2019

Publication Date:
06 September 2019 (online)

Abstract

Background We previously identified preparation of the internal mammary artery as a risk factor significantly impairing antibiotic tissue penetration into the presternal subcutaneous tissue. We, therefore, adapted our dosing schema regarding preoperative timing to overcome this risk factor.

Methods Eight patients who underwent coronary artery bypass grafting with a left internal mammary artery and vein grafts were included in this clinical trial. Cefazolin (4 g) was administered twice (3 hours and 1 hour) prior to skin incision and once during skin closure (2 g). Antibiotic concentrations were measured with subcutaneous microdialysis probes on both sternal sides. Results were directly compared with the previously published patient cohort receiving the standard schema (4 g cefazolin prior to skin incision and 2 g during closure).

Results All patients (7 male, 1 female, 69 ± 7 years, 26.3 ± 3.9 kg/m2) survived the perioperative period. Mean area under the curve on the right and left sternal side was 117.0 ± 92.5 μg/mL and 114.5 ± 83.2 μg/mL, respectively (p = 0.95). This was well above the previously measured mean peak tissue concentrations without early preoperative antibiotic administration on the side of mammary artery harvesting (52.4 ± 48.5 μg/mL vs. 13.1 ± 5.8 μg/mL; p = 0.039). The %fT > minimal inhibitory concentration (MIC) for Staphylococcus epidermidis and Staphylococcus aureus during the first 10 hours in presternal tissue was ≥ 70% but did not differ compared with standard schema.

Conclusions Early, additional preoperative administration of cefazolin was able to significantly increase peak tissue concentrations during surgery compared with the standard protocol. No difference, however, could be achieved in the percentage of time during which the concentration exceeded the MIC.

Author Disclosure Statement

Authors' Contribution

MA, DH, MZ, GL, WJ, and JH drafted the protocol and developed the study design. MA, WW, and AK performed surgical procedures and probe placement. ME, RT, and DH performed the anesthesia, probe placement, and sample collection. SS performed sample collection, sample transfer, and data preparation. AM and WJ performed the sample analyses and calculated the tissue concentrations. MA, MZ, and DH wrote the manuscript and calculated the results.


All authors reviewed the manuscript critically and approved the final version.