An additional dose of cefazolin for intraoperative prophylaxis

We examined the pancreatic tissue concentrations of cefazolin in ten patien ts undergoing pancreatectomy, and determined the optimal intraoperative tim e to deliver a repeat dose of cefazolin, An intravenous bolus dose of 1g ce fazolin was administered at the time of skin incision, Peripheral blood, su bcutaneous adipose tissue, and peritoneal samples were obtained intraoperat ively every hour for 4h after the antibiotic was first administered, and pa ncreatic tissue samples were obtained at the time of pancreatectomy. To det ermine adequate tissue levels of cefazolin, minimum inhibitory concentratio ns (MIC) were measured for four bacterial species, namely 360 isolates of m ethicillin-sensitive Staphylococcus aureus (MSSA), 204 isolates of Klebsiel la pneumoniae, 314 isolates of Escherichia coli, and 30 isolates of Strepto coccus spp. The antibiotic concentrations in adipose tissue and peritoneum 3h after the administration of cefazolin were lower than the MIC80 for K. p neumoniae, E. coli, and Streptococcus spp, Most pancreatic tissue samples s howed antibiotic concentrations greater than the MIC80 for these bacterial species; however, those from four patients complicated by severe chronic pa ncreatitis, massive intraoperative bleeding, or obesity showed concentratio ns lower than the MIG(80). Thus, we recommend that a second dose of cefazol in be given 3h after the first administration to maintain adequate levels o f antibiotic activity.