Medizinische Universität Graz - Research portal

Go directly to the nagivation.
Go directly to the content.

Navigation/Search

Selected Publication:

SHR Neuro Cancer Cardio Lipid Metab Microb

Andreas, M; Zeitlinger, M; Hoeferl, M; Jaeger, W; Zimpfer, D; Hiesmayr, JM; Laufer, G; Hutschala, D.
Internal mammary artery harvesting influences antibiotic penetration into presternal tissue.
Ann Thorac Surg. 2013; 95(4):1323-9; discussion 1329-30 Doi: 10.1016/j.athoracsur.2012.10.088
Web of Science PubMed FullText FullText_MUG

Leading authors Med Uni Graz: Andreas Martin
Co-authors Med Uni Graz: Zimpfer Daniel
Altmetrics:
Dimensions Citations:
Plum Analytics:
Scite (citation analytics):
Abstract:: BACKGROUND: Internal mammary artery (IMA) harvesting for coronary artery bypass grafting (CABG) influences tissue perfusion and represents a risk factor for deep sternal wound infection (DSWI). Cephalosporins are routinely administered for prophylaxis during cardiac operations to decrease perioperative wound infections. We hypothesized that mammary artery preparation impairs antibiotic penetration into presternal tissue during CABG. METHODS: Eight patients undergoing skeletonized left mammary artery harvesting for CABG were included. Standard antibiotic prophylaxis was administered: 4 g of cefazolin before skin incision and an additional 2 g during skin closure. Concentrations of cefazolin were measured in subcutaneous tissue on the presternal right and left sides (surgically affected) after sternotomy and additionally in subcutaneous tissue on the thigh (surgically unaffected) by microdialysis over a 10-hour period. RESULTS: Mean peak tissue concentration and the area under the curve (AUC) on the left sternal side were significantly reduced compared with the right side and compared with the thigh (mean peak concentration, 13.1±5.8 versus 24.1±4.7 and 27.8±9.7 μg/mL; p=0.005 and p=0.013; AUC 74.2±31.0 versus 110.4±25.0 and 140.3±46.3 μg×hours per milliliter; p=0.004 and p=0.002). Mean subcutaneous concentrations of cefazolin on the left sternal side exceeded the minimal inhibitory concentration (MIC90) of Staphylococcus epidermidis of 4 μg/mL in only 5 of 8 (37.5%) patients after 5 hours. CONCLUSIONS: IMA harvesting significantly impairs local antibiotic penetration during CABG. Common antibiotic dosing schemas should be reevaluated in this cardiac surgical setting.
Find related publications in this database (using NLM MeSH Indexing): Aged - administration & dosage; Anti-Bacterial Agents - administration & dosage, pharmacokinetics; Antibiotic Prophylaxis - methods; Cefazolin - administration & dosage, pharmacokinetics; Coronary Artery Bypass - methods; Dose-Response Relationship, Drug - administration & dosage; Female - administration & dosage; Follow-Up Studies - administration & dosage; Humans - administration & dosage; Male - administration & dosage; Mammary Arteries - transplantation; Microdialysis - methods; Risk Factors - administration & dosage; Sternum - blood supply, surgery; Surgical Wound Infection - metabolism, prevention & control; Tissue and Organ Harvesting - methods; Treatment Outcome - administration & dosage