Abstract
Background
Surgical site infections (SSI) occur despite antimicrobial prophylaxis and increase
postoperative morbidity and mortality. This could be caused by an intraoperative decrease
in antibiotic serum concentrations such as ampicillin after major abdominal surgery
due to blood loss and fluid therapy, which possibly promotes SSI. This hypothesis
was tested in the present study.
Methods
This pilot study was performed as a prospective observational trial between March
2018 and May 2019. Ampicillin/sulbactam was administered intravenously during anesthesia
induction. Fluid replacement was guided based on hemodynamic variables, including
analysis of pulse pressure variation. The primary outcome was ampicillin serum level
(ASL), measured after administration and hourly within 4 hours. The incidence of SSI
at hospital discharge was the secondary outcome. Linear mixed and logistic regression
models were used for statistical analyses.
Results
After screening of 133 adult patients, 129 were enrolled, and 102 completed the study
protocol. No correlation was found between the volume of intraoperative fluids and
ASL, nor was any association found between ASL and SSI. Based on 5 SSI cases, SSI
were associated with higher intraoperative fluid volume. ASL was sufficient to provide
intraoperative coverage for all potential bacterial strains.
Conclusion
Intraoperative fluid replacement had no effect on ASL up to 4 hours after ampicillin/sulbactam
administration. SSI were within an acceptable range, indicating adequate antimicrobial
prophylaxis, so intraoperative control of ASL does not seem necessary. In conclusion,
contrary to our initial hypothesis, ASL is not influenced by volume turnover or blood
loss during major surgery and therefore does not affect SSI.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: May 12, 2022
Accepted:
March 27,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
