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Higher versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More.
Surg Infect (Larchmt). 2018 Jul; 19(5):504-509.SI

Abstract

BACKGROUND

Clinical practice guidelines recommend a 2-g dose of cefotetan and cefoxitin for surgical prophylaxis. Pharmacokinetic data suggest benefit from higher cefotetan and cefoxitin dosing in obese patients. However, clinical studies examining higher dosing strategies in this at-risk population are lacking. The purpose of this study was to determine whether 3 g of cefotetan or cefoxitin administered pre-operatively for patients who weigh 120 kg or more is associated with a lower proportion of surgical site infection (SSI) compared with 2 g.

PATIENTS AND METHODS

Medical records of patients weighing 120 kg or more who had received cefotetan or cefoxitin (2 or 3 g) as surgical prophylaxis for intra-abdominal procedures between July 2012 and August 2015 were reviewed for the development of an SSI (primary outcome), study drug-related adverse events, and re-admissions attributed to SSIs (secondary outcomes). Relative risk calculations were performed for analysis of the primary and secondary outcomes.

RESULTS

One-hundred seventy-five procedures in 169 patients were included in the study. Cefotetan was used in 81% (141/175) of procedures. Three grams of cefotetan or cefoxitin was used in 20% (35/175) of procedures. The median body mass index (BMI) in both dosing groups was 42 kg/m2 and patients who received 3 g more often weighed more than 130 kg (relative risk [RR] 1.36, 1.01-1.76; p = 0.04). Surgical site infections occurred in 20.7% within the 2-g group and 22.9% in the 3-g group (RR 1.10, 0.55-2.20; p = 0.78). There was no difference in the number of study drug-related adverse effects in the 3-g compared with the 2-g group. Thirty-day re-admissions because of SSI also did not differ between the 2-g and 3-g groups (7.9% vs. 17.1%, respectively; p = 0.11).

CONCLUSION

This small retrospective study did not find a difference in SSI rates between 3-g and 2-g surgical prophylaxis dosing for patients 120 kg or more with a median BMI >40 kg/m2.

Authors+Show Affiliations

1 Department of Pharmacy, University of Maryland Medical Center , Baltimore, Maryland.2 Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital , Baltimore, Maryland.3 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.3 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.4 Division of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland.4 Division of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland. 5 Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland.3 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29717917

Citation

Banoub, Mary, et al. "Higher Versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More." Surgical Infections, vol. 19, no. 5, 2018, pp. 504-509.
Banoub M, Curless MS, Smith JM, et al. Higher versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More. Surg Infect (Larchmt). 2018;19(5):504-509.
Banoub, M., Curless, M. S., Smith, J. M., Jarrell, A. S., Cosgrove, S. E., Rock, C., & Avdic, E. (2018). Higher versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More. Surgical Infections, 19(5), 504-509. https://doi.org/10.1089/sur.2017.296
Banoub M, et al. Higher Versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More. Surg Infect (Larchmt). 2018;19(5):504-509. PubMed PMID: 29717917.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher versus Lower Dose of Cefotetan or Cefoxitin for Surgical Prophylaxis in Patients Weighing One Hundred Twenty Kilograms or More. AU - Banoub,Mary, AU - Curless,Melanie S, AU - Smith,Janessa M, AU - Jarrell,Andrew S, AU - Cosgrove,Sara E, AU - Rock,Clare, AU - Avdic,Edina, Y1 - 2018/05/02/ PY - 2018/5/3/pubmed PY - 2018/10/16/medline PY - 2018/5/3/entrez KW - antibiotic prophylaxis KW - cefotetan KW - cefoxitin KW - dose/dosing KW - obese/obesity KW - surgical site infection SP - 504 EP - 509 JF - Surgical infections JO - Surg Infect (Larchmt) VL - 19 IS - 5 N2 - BACKGROUND: Clinical practice guidelines recommend a 2-g dose of cefotetan and cefoxitin for surgical prophylaxis. Pharmacokinetic data suggest benefit from higher cefotetan and cefoxitin dosing in obese patients. However, clinical studies examining higher dosing strategies in this at-risk population are lacking. The purpose of this study was to determine whether 3 g of cefotetan or cefoxitin administered pre-operatively for patients who weigh 120 kg or more is associated with a lower proportion of surgical site infection (SSI) compared with 2 g. PATIENTS AND METHODS: Medical records of patients weighing 120 kg or more who had received cefotetan or cefoxitin (2 or 3 g) as surgical prophylaxis for intra-abdominal procedures between July 2012 and August 2015 were reviewed for the development of an SSI (primary outcome), study drug-related adverse events, and re-admissions attributed to SSIs (secondary outcomes). Relative risk calculations were performed for analysis of the primary and secondary outcomes. RESULTS: One-hundred seventy-five procedures in 169 patients were included in the study. Cefotetan was used in 81% (141/175) of procedures. Three grams of cefotetan or cefoxitin was used in 20% (35/175) of procedures. The median body mass index (BMI) in both dosing groups was 42 kg/m2 and patients who received 3 g more often weighed more than 130 kg (relative risk [RR] 1.36, 1.01-1.76; p = 0.04). Surgical site infections occurred in 20.7% within the 2-g group and 22.9% in the 3-g group (RR 1.10, 0.55-2.20; p = 0.78). There was no difference in the number of study drug-related adverse effects in the 3-g compared with the 2-g group. Thirty-day re-admissions because of SSI also did not differ between the 2-g and 3-g groups (7.9% vs. 17.1%, respectively; p = 0.11). CONCLUSION: This small retrospective study did not find a difference in SSI rates between 3-g and 2-g surgical prophylaxis dosing for patients 120 kg or more with a median BMI >40 kg/m2. SN - 1557-8674 UR - https://www.unboundmedicine.com/medline/citation/29717917/Higher_versus_Lower_Dose_of_Cefotetan_or_Cefoxitin_for_Surgical_Prophylaxis_in_Patients_Weighing_One_Hundred_Twenty_Kilograms_or_More L2 - https://www.liebertpub.com/doi/full/10.1089/sur.2017.296?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -