PMID- 27317707
OWN - NLM
STAT- MEDLINE
DCOM- 20180806
LR  - 20181113
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 117
IP  - 1
DP  - 2016 Jul
TI  - Skeletal muscle and plasma concentrations of cefazolin during complex paediatric 
      spinal surgery.
PG  - 87-94
LID - 10.1093/bja/aew032 [doi]
AB  - BACKGROUND: Surgical site infections (SSIs) can have devastating consequences for 
      children who undergo spinal instrumentation. Prospective evaluations of 
      prophylactic cefazolin in this population are limited. The purpose of this study 
      was to describe the pharmacokinetics and skeletal muscle disposition of 
      prophylactic cefazolin in a paediatric population undergoing complex spinal 
      surgery. METHODS: This prospective pharmacokinetic study included 17 children 
      with adolescent idiopathic scoliosis undergoing posterior spinal fusion, with a 
      median age of 13.8 [interquartile range (IQR) 13.4-15.4] yr and a median weight 
      of 60.6 (IQR 50.8-66.0) kg. A dosing strategy consistent with published 
      guidelines was used. Serial plasma and skeletal muscle microdialysis samples were 
      obtained during the operative procedure and unbound cefazolin concentrations 
      measured. Non-compartmental pharmacokinetic analyses were performed. The amount 
      of time that the concentration of unbound cefazolin exceeded the minimal 
      inhibitory concentration for bacterial growth for selected SSI pathogens was 
      calculated. RESULTS: Skeletal muscle concentrations peaked at a median of 37.6 
      (IQR 26.8-40.0) microg ml(-1) within 30-60 min after the first cefazolin 30 mg kg(-1) 
      dose. For patients who received a second 30 mg kg(-1) dose, the peak 
      concentrations reached a median of 40.5 (IQR 30.8-45.7) microg ml(-1) within 30-60 
      min. The target cefazolin concentrations for SSI prophylaxis for 
      meticillin-sensitive Staphylococcus aureus (MSSA) and Gram-negative pathogens 
      were exceeded in skeletal muscle 98.9 and 58.3% of the intraoperative time, 
      respectively. CONCLUSIONS: For children with adolescent idiopathic scoliosis 
      undergoing posterior spinal fusion, the cefazolin dosing strategy used in this 
      study resulted in skeletal muscle concentrations that were likely not to be 
      effective for intraoperative SSI prophylaxis against Gram-negative pathogens.
CI  - (c) The Author 2016. Published by Oxford University Press on behalf of the British 
      Journal of Anaesthesia. All rights reserved. For Permissions, please email: 
      journals.permissions@oup.com.
FAU - Himebauch, A S
AU  - Himebauch AS
AD  - Department of Anesthesiology and Critical Care Medicine Center for Clinical 
      Pharmacology himebaucha@email.chop.edu.
FAU - Sankar, W N
AU  - Sankar WN
AD  - Department of Surgery, Division of Orthopedic Surgery.
FAU - Flynn, J M
AU  - Flynn JM
AD  - Department of Surgery, Division of Orthopedic Surgery.
FAU - Sisko, M T
AU  - Sisko MT
AD  - Department of Anesthesiology and Critical Care Medicine.
FAU - Moorthy, G S
AU  - Moorthy GS
AD  - Center for Clinical Pharmacology.
FAU - Gerber, J S
AU  - Gerber JS
AD  - Department of Pediatrics, Division of Infectious Diseases.
FAU - Zuppa, A F
AU  - Zuppa AF
AD  - Department of Anesthesiology and Critical Care Medicine Center for Clinical 
      Pharmacology.
FAU - Fox, E
AU  - Fox E
AD  - Center for Clinical Pharmacology Department of Pediatrics, Division of Oncology, 
      Perelman School of Medicine, University of Pennsylvania and The Children's 
      Hospital of Philadelphia, Philadelphia, PA, USA.
FAU - Dormans, J P
AU  - Dormans JP
AD  - Division of Orthopedic Surgery, Texas Children's Hospital, Houston, TX 77030, 
      USA.
FAU - Kilbaugh, T J
AU  - Kilbaugh TJ
AD  - Department of Anesthesiology and Critical Care Medicine.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 0 (Anti-Bacterial Agents)
RN  - IHS69L0Y4T (Cefazolin)
SB  - IM
CIN - Br J Anaesth. 2016 Jul;117(1):3-5. PMID: 27317702
MH  - Adolescent
MH  - Anti-Bacterial Agents/blood/metabolism/*pharmacokinetics
MH  - Cefazolin/blood/metabolism/*pharmacokinetics
MH  - Female
MH  - Humans
MH  - Male
MH  - Muscle, Skeletal/*metabolism
MH  - Pediatrics
MH  - Prospective Studies
MH  - Scoliosis/*surgery
MH  - *Spinal Fusion
MH  - Surgical Wound Infection/*prevention & control
PMC - PMC4913389
OTO - NOTNLM
OT  - cefazolin
OT  - microdialysis
OT  - paediatric
OT  - scoliosis
OT  - surgery, spinal
EDAT- 2016/06/19 06:00
MHDA- 2018/08/07 06:00
PMCR- 2017/07/01
CRDT- 2016/06/19 06:00
PHST- 2015/01/09 00:00 [accepted]
PHST- 2016/06/19 06:00 [entrez]
PHST- 2016/06/19 06:00 [pubmed]
PHST- 2018/08/07 06:00 [medline]
PHST- 2017/07/01 00:00 [pmc-release]
AID - S0007-0912(17)31404-6 [pii]
AID - aew032 [pii]
AID - 10.1093/bja/aew032 [doi]
PST - ppublish
SO  - Br J Anaesth. 2016 Jul;117(1):87-94. doi: 10.1093/bja/aew032.