Influence of the Obesity Phenotype on the Adequacy of Antibiotic Prophylaxis with Cefoxitin for Obese Patients Undergoing Bariatric Surgery: Lessons Learnt and Future Considerations
| Autor: | Julien Scala-Bertola, Amandine Luc, Jeffrey Lipman, Emmanuel Novy, Thibaut Belveyre, Mathieu Esposito |
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| Přispěvatelé: | Service d'Anesthésiologie et de Soins Intensifs [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Régional de PharmacoVigilance de Lorraine (CRPV Lorraine), CRHU Nancy, University of Queensland [Brisbane] |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty [SDV]Life Sciences [q-bio] Population Bariatric Surgery 030226 pharmacology & pharmacy Body Mass Index Cohort Studies 03 medical and health sciences Cefoxitin 0302 clinical medicine Sex Factors Pharmacokinetics Tandem Mass Spectrometry medicine Humans Pharmacology (medical) Obesity Prospective Studies Antibiotic prophylaxis education ComputingMilieux_MISCELLANEOUS Chromatography High Pressure Liquid Pharmacology Metabolic Syndrome education.field_of_study business.industry Antibiotic Prophylaxis Middle Aged medicine.disease 3. Good health Surgery Anti-Bacterial Agents Phenotype 030220 oncology & carcinogenesis Pharmacodynamics Lean body mass Female Metabolic syndrome business medicine.drug |
| Zdroj: | European journal of drug metabolism and pharmacokinetics European journal of drug metabolism and pharmacokinetics, Springer, 2021, 46 (4), pp.479-485. ⟨10.1007/s13318-021-00688-y⟩ |
| ISSN: | 2107-0180 0378-7966 |
| Popis: | A high inter-individual variability in pharmacokinetic parameters in obese patients is observed. The objective of this study was to evaluate the effect of obesity parameters on the pharmacokinetics of cefoxitin administered for antibiotic prophylaxis during bariatric surgery. This a secondary analysis of a pharmacokinetic study involving 174 obese patients scheduled for bariatric surgery and receiving a 4-g dose of cefoxitin. Blood samples were collected at incision and wound closure. The total plasma concentrations were assessed utilising a validated high-performance liquid chromatography–tandem mass spectrometry method. The pharmacokinetic and pharmacodynamic target was defined as an estimated free concentration of cefoxitin at the time of wound closure >8 mg/L. Specific evaluated obesity parameters were fat body mass, fat body mass/height2, lean body mass, lean body mass/height2, visceral adipose tissue and presence of a metabolic syndrome. A total of 174 patients (median age 47 years) with a majority of women (75.3%) and a median BMI of 44 kg/m2 were analysed. The percentage of patients who met the pharmacokinetic and pharmacodynamic target was 85.1%. In the whole population, a tendency to fail to reach the target was observed with a higher lean mass over height2 [OR = 0.79; 95% CI (0.62–1.01); P = 0.060]. In the female subgroup, higher lean mass over height2 [OR = 0.63; 95% CI (0.41–0.97); P = 0.037] and the presence of a metabolic syndrome [OR = 0.17; 95% CI (0.03–0.83); P = 0.030] were associated with failure to reach the pharmacokinetic and pharmacodynamic target. Obese patients with a higher lean mass and a metabolic syndrome could constitute a subgroup at risk for cefoxitin under-dosage. |
| Databáze: | OpenAIRE |
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