Ceftaroline as salvage therapy for methicillin susceptible staphylococcus aureus complicated bacteremia / Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Abstract Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with com plicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

Resumen Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimen taron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Cefazolin prophylactic efficacy on prosthetic joint infection after primary hip arthroplasty / Eficácia profilática da cefazolina sobre a infecção protética articular após artroplastia primária de quadril

ABSTRACT Objective Perioperative deep prosthetic joint infection (PJI) is a serious postoperative complication of total hip arthroplasty (THA). We aimed to compare the efficacy of cefazolin administered within 24 and 48 h of primary THA for PJI prophylaxis. Methods In this retrospective study, 720 patients were divided into two groups depending on whether cefazolin was administered as a single injection of 2 g twice daily within 24 (24-h group) or 48 h of surgery and the following day (48-h group). Sex, age at surgery, body mass index, co-existing diseases, blood test data, and PJI risk factors were evaluated. Results The 24- and 48-h groups included 364 and 356 patients, respectively. Diabetes mellitus was the most common risk factor for PJI in both groups. The corresponding incidence of perioperative deep PJI following primary THA was 0.55% and 0.28% in the 24- and 48-h groups, respectively. There was no significant difference in patient background characteristics between the groups. Conclusions Cefazolin administration within 24 h of primary THA may be appropriate for perioperative deep PJI. Level of Evidence II; Retrospective study.

RESUMO Objetivo A infecção de prótese articular (IPA) perioperatória profunda é uma grave complicação pós-operatória da artroplastia total de quadril (ATQ). Este estudo buscou comparar a eficácia da cefazolina administrada dentro de 24 e 48 horas após ATQ para profilaxia de IPA. Métodos Neste estudo retrospectivo, 720 pacientes foram divididos em dois grupos, que receberam cefazolina em uma injeção de 2g duas vezes por dia nas primeiras 24 e 48 horas (grupos de 24 e 48 horas), respectivamente. Foram avaliados sexo, idade na data da cirurgia, índice de massa corporal, comorbidades, testes sanguíneos e fatores de risco para IPA. Resultados Os grupos de 24 e 48 horas incluíram, respectivamente, 364 e 356 pacientes. O fator de risco para IPA mais comum nos dois grupos foi o diabetes mellitus. A incidência de IPA perioperatória profunda após ATQ foi, respectivamente, de 0,55% e 0,28% nos grupos de 24 e 48 horas. Não houve diferença significativa nas características gerais dos pacientes entre os dois grupos. Conclusão A administração de cefazolina dentro de 24 horas após ATQ primária pode ser adequada para IPA perioperatória profunda. Nível de Evidência II; Estudo retrospectivo.

Research on polymer impurities in cefazolin sodium raw materials and products / 药学学报

Research on polymer impurities has always been important in the quality control of cephalosporins. Research on polymers in cephalosporins that lack active amino groups on the C-7 side chain has not been reported. Therefore, our study used cefazolin sodium, which is widely used in the clinic, as an example. The polymer in cefazolin sodium and its product "cefazolin sodium pentahydrate for injection" was analyzed by column switching liquid chromatography-high resolution mass spectrometry. Two polymer impurity peaks were detected and the possible structures of these polymers were suggested. Through two-dimensional liquid chromatography, the chromatographic peaks following Sephadex gel chromatography and high-performance gel chromatography were compared to those obtained by reverse high-performance liquid chromatography (HPLC) for cefazolin sodium as reported in the Chinese Pharmacopoeia. The HPLC method proves more suitable for polymer detection than Sephadex gel chromatography and high-performance gel chromatography. The method of polymer detection for cefazolin sodium was established using the method of related substances HPLC as described in the Chinese Pharmacopoeia.

Cefazolin sodium pentahydrate combined with vacuum sealing drainage in the treatment of open fracture complicated with soft tissue injury

SUMMARY OBJECTIVE To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

RESUMO OBJETIVO Investigar a eficácia clínica do cefazolin penta-hidrato de sódio combinado com drenagem por vedação a vácuo (VSD) no tratamento da fratura exposta complicada com lesão nos tecidos moles. MÉTODOS Sessenta e três doentes com fratura exposta complicada com lesões nos tecidos moles foram divididos em grupos de observação (n=33) e controle (n=30). Após redução cirúrgica, fixação e reparação da fratura, o grupo de controle foi tratado com VSD durante dez dias e o grupo de observação foi tratado com cefazolina penta-hidrato de sódio com base no VSD durante dez dias. O tempo de controle de infecção foi gravado. Após o tratamento, a dor dos doentes foi avaliada. Antes e após o tratamento, foram detectados os níveis séricos de proteína C-reativa (CRP), interleucina (IL)-6, IL -8, fator de necrose tumoral alfa (TNF-α), cortisol, epinefrina, norepinefrina e glicose. Após seis meses de tratamento, a taxa efetiva total de tratamento foi avaliada. RESULTADOS O tempo de controle da infecção e a pontuação da Escala Visual Analógica após o tratamento no grupo de observação foram significativamente inferiores ao do grupo de controle, respectivamente (P<0,05). Após o tratamento, os níveis séricos de CRP, IL-6, IL-8, TNF-α, cortisol, epinefrina, norepinefrina e glicose em cada grupo foram significativamente menores do que antes do tratamento, respectivamente (P<0,05), e cada índice de observação foi significativamente inferior ao do grupo de controle (P<0,05). CONCLUSÃO No tratamento da fratura exposta complicada com lesões nos tecidos moles, o cefazolin penta-hidrato de sódio combinado com VSD pode efetivamente reduzir a inflamação e o estresse, melhorando assim a eficácia do tratamento.

Human amniotic membrane as a drug carrier – An in-vitro study using fortified cefazolin ophthalmic solution

Purpose: Our previous study demonstrated the drug reservoir function of human amniotic membrane (HAM) using stable moxifloxacin as a model drug. The purpose of the present study is to evaluate whether HAM can be used as a drug carrier for extended release of extemporaneous preparation of cefazolin. Methods: HAM Buttons (1 Control, 5 Test) were incubated in a freshly prepared (1 ml) sterile topical solution of cefazolin 5% (w/v) for 3 h and 24 h at two different temperatures. The groups were designated as follows: Group IA: Soaking duration 3 h at 4°C; Group IB: Soaking duration 3 h at room temperature; Group IIA: Soaking duration 24 h at 4°C; and Group IIB: Soaking duration 24 h at room temperature. The release kinetics of cefazolin from different groups of drug-laden HAM was studied for a period of 5 days. Samples were assayed for estimation of cefazolin content at different time intervals by High Performance Liquid Chromatography (HPLC) with Photodiode array (PDA) detector. Results: Three-hour cefazolin treatment with HAM at 4°C caused high drug entrapment (24%) compared to room temperature (11%; P < 0.005); however, the release kinetics was not significantly different between Group IA and IB as well as Group IIA and IIB up to the study period. Increase in drug treatment duration did not show increase in entrapment, but caused two-fold (IA Vs IIA) and 1.6-fold (IB Vs IIB) less drug entrapment at 4°C and room temperature, respectively. Conclusion: The results reveal that HAM may be a suitable drug carrier for extended delivery of fortified formulations without compromising stability.

Systematic Retrospective and Review of Anaphylactic Shock Induced by Cefazolin Sodium with Negative Skin Test / 中国药学杂志

OBJECTIVE: To systematicly review and analyse the clinical characteristics of anaphylactic shock induced by cefazolin sodium with negative skin test, and provide a basis for the safe and reasonable application of cefazolin sodium. METHODS: Databases of PUBMED, EMBASE, CBM, CNKI, VIP and WANFANG data(from built to October 2017)were conducted for case reports published in English or Chinese involving anaphylactic shock induced by cefazolin sodium. Literatures were screened, extracted and statistic analysed by two authors independently. RESULTS: A total of 1 358 literatures were searched out and 18 were included involving 20 patients, the median age was 39.0 years, 60.0% of the patients had no history of penicillin or drug allergy, and 30.0% of the patients had used penicillin or cephalosporin antibiotics, and intravenous infusion was the main route of administration. Anaphylactic shock occurred within 30 min accouted for 47.6%, and the longest time occurred on the 7th day of medication. The clinical manifestations were mainly circulatory system damage, and the rescue measures included discontinuation of medicine immediately, prostration, establishment of intravenous channels, oxygen uptake, administration of vasoactive drugs and glucocorticoids, etc., all of which were eventually successfully rescued.The correlation evaluation of ADR was definite and probable in 1 and 19 cases, respectively. CONCLUSION: High attention should be put on anaphylactic shock induced by cefazolin sodium with negative skin test. The proportion of young people and immediate anaphylactic shock were high.The cefazolin sodium skin test is of little value in predicting anaphylaxis. History of medication and allergies of patients should be taken in detail before medication, and the whole-process of medication, especially within 30 min should be closely monitored. Emergency rescue measures of anaphylactic shock should be prepared in advance.

Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics

Estudio de susceptibilidad a cefalosporinas de primera generación en enterobacterias aisladas de urocultivo, según criterios CLSI y EUCAST / Susceptibility to first-generation Cephalosporins in Enterobacteriaceae isolated from urine culture according to CLSI and EUCAST breakpoints

Resumen Actualmente se recomienda el uso de cefazolina para determinar la susceptibilidad a cefalosporinas orales de primera generación en cepas de enterobacterias en ITU no complicada. Nuestro objetivo fue establecer la susceptibilidad a cefalosporinas orales en cepas urinarias según puntos de corte para cefalotina o cefazolina y la correlación de susceptibilidad entre cefazolina y cefadroxilo. Se estudió la concordancia entre cefalotina y cefazolina en 52 cepas por método de Kirby-Bauer y Vitek XL. En Escherichia coli fue de 0% para VitekXL y 50% para Kirby-Bauer. La concordancia entre cefazolina y cefadroxilo fue 95,6%. En el laboratorio debiera usarse cefazolina para determinar susceptibilidad a cefalosporinas orales de primera generación. La concordancia entre cefazolina y cefadroxilo sugiere que cefazolina podría predecir susceptibilidad para cefadroxilo.

Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.

Participation of Clinical Pharmacists in One Case of Late-onset Infection after Artificial Hip Joints Replace-ment / 中国药师

In order to explore the value of clinical pharmacist in the anti-infective treatment of the patients with late-onset infec-tion after artificial hip joints replacement,clinical pharmacists performed ward round and pharmaceutical care for one patient with infec-tion around the artificial joints after artificial hip joints replacement three years ago. According to the relevant literatures,clinical phar-macist provided medical advice for physician from the following aspects: surgical interventions, drug choice and dosage adjustment, and participated in the medicine therapeutic scheme for the patient. Physicians partly accepted the suggestions of clinical pharmacists, and the symptoms and imaging examination results of the patient improved after the treatment,which provided guarantee for the follow-up treatment. It is of great significance for clinical pharmacists to participate in the formulation of clinical medication plan to improve the rational drug use in clinical anti-infection treatment.

Cefazolin concentration in the mediastinal adipose tissue of patients undergoing cardiac surgery

Abstract Objective: To measure the concentration of cefazolin in the anterior mediastinal adipose tissue of patients undergoing cardiac surgery, determining the variation of cefazolin concentration. Methods: Two samples of approximately 1g of subcutaneous tissue were collected from 19 patients who underwent surgery in December 2015: the first sample was collected right after sternotomy and the second one, before sternal synthesis with steel wires. Antibiotic dosage was administered through high performance liquid chromatography. Results: We observed a positive and statistically significant correlation between time 1 and cefazolin concentration (r=0.489 and P=0.039). For time 2 and cefazolin concentration, there was a negative and statistically significant correlation between both variables (r=-0.793 and P<0.001). A negative correlation was also observed between body mass index and cefazolin concentration at time 2 (r=-0.510 and P=0.031). The regression model showed that every 1-minute increase in time 1 corresponded to an increase of 0.240 µg/dL in cefazolin concentration, whereas every 1-minute increase in time 2 corresponded to a reduction of 0.046 µg/dL in cefazolin concentration. As for body mass index, every 1 kg/m2 increase corresponded to a reduction of about 0.510 µg/dL in cefazolin concentration. Conclusion: There was a positive and significant correlation between the initial time of surgery and cefazolin level in the first dosage. The evaluation of the second dosage showed a negative and significant correlation between cefazolin level and the second time of dosage. The concentration of cefazolin is under the influence of body mass index.

Cost-effectiveness Analysis of Cefazolin Sodium Pentahydrate versus Cefazolin Sodium in the Treatment of Bacterial Infection / 中国药房

OBJECTIVE:To compare the cost-effectiveness of cefazolin sodium pentahydrate versus cefazolin sodium in treat-ment of bacterial infection,and to provide reference for rational drug use in the clinic.METHODS:In retrospective study,207 bac-terial infection patients receiving cefazolin sodium pentahydrate or cefazolin sodium were selected from our hospital during Nov. 2014 to Dec. 2015,including 109 cases in cefazolin sodium pentahydrate group and 98 cases in cefazolin sodium group. Both groups received relevant medicine 2 g,bid,ivgtt,within 7 d. The clinical efficacies,bacteriological efficacies and safety of 2 groups were compared,and pharmacoeconomics of 2 therapy plans were evaluated.RESULTS:The clinical response rates of cefazo-lin sodium pentahydrate group and cefazolin sodium group were 89.91% and 74.49%,with statistical significance(P<0.05);bac-terial clearance rates were 76.32% and 72.13%,with no statistical significance(P>0.05). No drug-related ADR occurred in 2 groups during the treatment. Total shot-term(7 d)cost of cefazolin sodium pentahydrate group and cefazolin sodium group respec-tively were 4 391.43 yuan and 3 396.19 yuan. Using clinical response rate as effect index,cost-effectiveness ratio of them were 48.84 and 45.59,and incremental cost-effectiveness ratio was 64.55,which was lower than per capita GDP of Hengshui city. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS:Under the current economic sit-uation of Hengshui city,cefazolin sodium pentahydrate has cost-effectiveness advantage in the treatment of bacterial infection than cefazolin sodium.

Cost-effectiveness Analysis of Cefazolin Sodium Pentahydrate versus Cefazolin Sodium in the Treatment of Bacterial Infection / 中国药房

OBJECTIVE:To compare the cost-effectiveness of cefazolin sodium pentahydrate versus cefazolin sodium in treat-ment of bacterial infection,and to provide reference for rational drug use in the clinic.METHODS:In retrospective study,207 bac-terial infection patients receiving cefazolin sodium pentahydrate or cefazolin sodium were selected from our hospital during Nov. 2014 to Dec. 2015,including 109 cases in cefazolin sodium pentahydrate group and 98 cases in cefazolin sodium group. Both groups received relevant medicine 2 g,bid,ivgtt,within 7 d. The clinical efficacies,bacteriological efficacies and safety of 2 groups were compared,and pharmacoeconomics of 2 therapy plans were evaluated.RESULTS:The clinical response rates of cefazo-lin sodium pentahydrate group and cefazolin sodium group were 89.91% and 74.49%,with statistical significance(P<0.05);bac-terial clearance rates were 76.32% and 72.13%,with no statistical significance(P>0.05). No drug-related ADR occurred in 2 groups during the treatment. Total shot-term(7 d)cost of cefazolin sodium pentahydrate group and cefazolin sodium group respec-tively were 4 391.43 yuan and 3 396.19 yuan. Using clinical response rate as effect index,cost-effectiveness ratio of them were 48.84 and 45.59,and incremental cost-effectiveness ratio was 64.55,which was lower than per capita GDP of Hengshui city. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS:Under the current economic sit-uation of Hengshui city,cefazolin sodium pentahydrate has cost-effectiveness advantage in the treatment of bacterial infection than cefazolin sodium.

Observation of myrtol combined with cefazolin sodium pentahydrate in the treatment of pediatric acute suppurative otitis media / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effectof Myrtol combined with Cefazolin Sodium Pentahydrate in the treatment of acute suppurative otitis media in children. METHODS Totally 120 cases of pediatric acute suppurative otitis media were selected in our hospital from January 2014 to January 2016 and randomly divided into four groups, treated with Myrtol combined with Cefazolin Sodium Pentahydrate, Myrtol combined with Cefazolin Sodium, Cefazolin Sodium Pentahydrate, or Cefazolin Sodium, respectively. The effect and adverse reactions of the 4 groups were studied and compared. RESULTS There was no significant differences in age, sex, and average course of disease among the four groups. In Myrtol combined with Cefazolin Sodium Pentahydrate group, the clinical efficacy is better than that of the other three groups (P0.05), and both of them are better than cefazolin sodium group(P0.05). CONCLUSION Myrtol combined with Cefazolin Pentahydrate Sodium treatment was superior to the other three protocols in clinical efficacy for children with acute suppurative otitis media , and does do not increase the risk of safety.

Nodular Vasculitis Associated with Cefazolin / 대한피부과학회지

No abstract available.

The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh

Aim: This study aimed to evaluate the role of cefazolin in prevention of various infections after abdominal wall repair by mesh. Materials and methods: This is a prospective study consisted of 300 patients with various kinds of hernia (inguinal, femoral, bilateral, incisional, umbilical and lumbar hernias who were treated for elective mesh repair in from September 2010 to October 2014. Results: In the present study, 300 patients with different kinds of hernia were selected for elective surgery. Of them 200 patients (66.6%) were males and 100 patients (33.4%) were females with mean age of 50-55 years. Patients were assigned into study group and control group. 180 patients (60%) received prophylactic cefazolin, this group was named as study group and 120 patients (40%) were named as control group and did not receive any prophylactic antibiotics. The mean age of patients in control group was 51.5±13.45 years and that in study group was 53.0±15.75 years which was not significantly different. (p =0.05). 22 patients (18.3%) of 120 control group patients had epigastric hernia, 18 patients (15%) had incisional hernia, 46 patients (38.3) had inguinal hernia, 34 patients (28.3%) had umbilical hernia and all these patients were not given any prophylactic antibiotics. 44 patients (24.4%) of 180 study patients had epigastric hernia, 31 patients (17.2%) had incisional hernia, 85 patients (47.2%) had inguinal hernia and 20 patients (11.1) had umbilical and all these patients were given prophylactic antibiotic. One patient who received rives repair in the study group developed deep surgical site infection which necessitated readmission and partial debridement of the mesh without complete excision. T. Uma Maheswara Rao. The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh. IAIM, 2016; 3(6): 124-129. Page 125 Conclusion: This study results did not support the use of cephazolin as a prophylactic for various kinds of abdominal wall hernia repair with mesh

ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem / Antibioticoprofilaxia em cirurgia bariátrica: infusão contínua de cefazolina versus ampicilina/sulbactam e ertapenem

Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients. .

Contexto A incidência de infecção de sítio cirúrgico em pacientes bariátricos é significativa e as recomendações atuais para a profilaxia antibiótica são por vezes inadequadas. Objetivo O objetivo deste estudo foi analisar o efeito de três esquemas de antibióticos profiláticos sobre a incidência de infecção de sítio cirúrgico. Método Estudo prospectivo, transversal, foi realizado entre janeiro de 2009 e janeiro de 2013, em que 896 derivações gástricas em Y de Roux foram realizadas para tratar a obesidade. O estudo comparou três grupos de pacientes de acordo com a profilaxia antibiótica administrada no perioperatória por via intravenosa, iniciada na indução anestésica: Grupo I constituído de 194 pacientes tratados com duas doses de 3 g de ampicilina/sulbactam; Grupo II com 303 pacientes tratados com uma única dose de 1 g de ertapenem; e Grupo III com 399 pacientes tratados com uma dose de 2 g de cefazolina no momento da indução da anestésica seguida de uma infusão contínua de cefazolina 1 g durante o procedimento cirúrgico. A taxa de infecção de sítio cirúrgico foi analisada, bem como a sua associação com a idade, sexo, peso pré-operatório, o índice de massa corporal e comorbidades. Resultados As taxas de infecção do sítio cirúrgico foram de 4,16% no grupo tratado profilaticamente com ampicilina/sulbactam, 1,98% no grupo de ertapenem e 1,55% no grupo de cefazolina contínua. Conclusão O uso profilático de cefazolina contínua em cirurgias para obesidade mórbida apresenta resultados muito promissores. Estes resultados sugerem que alguns regimes profiláticos precisam ser reconsiderados e até mesmo substituídos por terapias mais eficazes para a prevenção de infecções de sítio cirúrgico em pacientes bariátricos. .

Epidemiology of the Postoperative Bacteriuria and Urinary Tract Infections Following Transurethral Resection of the Prostate.

Aims: Despite guidelines and recommendations, a pragmatic approach, i.e., that treatment will improve patient-centered outcomes when performed by typical clinicians in typical patients, is necessary to evaluate the effectiveness of antibiotic prophylaxis in urological surgery. Study Design: Prospective, randomized, double-blinded, pragmatic trial. Place and Duration: The study was performed in a tertiary hospital at Federal University of Uberlandia, Brazil, from January 2012 to December 2013. Methods: One hundred and thirty patients were randomly assigned to receive a single dose of 2 g intravenous (IV) ceftriaxone (66 subjects) or 2 g IV cefazolin (64 subjects) thirty minutes before transurethral resection of the prostate (TURP). We evaluated their physical status, preoperative urinary catheter use, urological risk factors, prostate size, and the duration of surgery. Results: Ceftriaxone showed a non-significant trend towards superiority to cefazolin (OR = 0.567, 95% CI [0.234-1.414], p = 0.228) for the prevention of infections among TURP patients. Conclusion: No significant difference in the effectiveness of a single dose of ceftriaxone compared with cefazolin for the prevention of postoperative infections was found in patients undergoing TURP following the early postoperative removal of an indwelling catheter. Due to the pragmatic assumptions of this trial, this result might not represent a negative finding; instead, it may indicate the importance of risk factors influencing the patients’ susceptibility to infection.

Analysis of Risk Factors in Adverse Reaction of Cefazolin Drugs by Logistics Model / 中国药房

OBJECTIVE:To explore the risk factors of adverse reaction of cefazolin drugs by Logistic model. METHODS:Re-lated information was collected from the information system of our hospital,and SPSS 19.0 software was conducted for statistical analysis. RESULTS:Totally 855 patients were enrolled,30 of which had adverse reactions(3.51%). According to the results of Logistic analysis,intravenous administration with the concentration of ≥20 mg/ml (OR=7.857,95% CI:1.566-39.431,P=0.003) was the risk factor of adverse reaction of cefazolin drugs when single dose was above 2 g (OR=13.75,95% CI:2.423-78.028,P1.75 g with ad-ministration time of 0:00-9:05 and concentration of above 7 mg/ml. According to the predictive thresholds,the risk of patients with adverse reaction can be predicted to promote safe and effective use of cefazolin.

A diagnostic workup of perioperative anaphylaxis reveals a selective type 1 hypersensitivity to cefazolin

Abstract: Anaphylaxis in the operating room although infrequent can be potentially fatal.1 The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed.2 Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered.3 Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.

What Should Be Considered to Cause the Early Post-Craniotomy Seizure: Antibiotics (Cefazolin) Irrigation

OBJECTIVE: Post-craniotomy seizure (PCS) is reported only rarely. However, our department noted a 433% increase in PCS for a year beginning September 2010, especially after cerebrovascular surgery. Our goal was to identify the cause of our unusual outbreak of PCS. METHODS: For almost one year after September 2010, cases of PCS increased significantly in our department. We analyzed 973 patients who had received a major craniotomy between January 2009 and November 2011. We included seizures that occurred only in the first 24 postoperative hours, which we defined as early PCS. After verifying the presence of PCS, we analyzed multiple seizure-provoking factors and their relation to the duration and character of seizure activity. RESULTS: Overall PCS incidence was 7.2% (70/973). Cefazolin (2 g/L saline) was the antibiotic drug used for intraoperative irrigation in 88.4% of the operations, and no PCS occurred without intraoperative cefazolin irrigation. When analyzed by operation type, clipping surgery for unruptured aneurysms was the most frequently associated with PCS (80%). Using logistic regression, only 2 g cefazolin intraoperative irrigation (p=0.024) and unruptured aneurysm clipping surgery (p<0.001) were associated with early PCS. The seizure rate of unruptured aneurysm clipping surgery using 2 g cefazolin intraoperative irrigation was 32.9%. CONCLUSION: Intraoperative cefazolin irrigation must be avoided in patients undergoing craniotomy, especially for clipping of unruptured aneurysms, because of the increased risk of early PCS.