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INTRODUCTION
Mediastinitis is a serious infectious complication in the postoperative period of cardiovascular surgery[1]. The overall incidence of deep sternal wound infections (DSWI) ranges from 0.4% to 5%. Despite the low incidence, damage to patients and hospital costs are substantial[2].
Antibiotic prophylaxis is one of the main preventive measures. The importance of prophylactic antibiotics for cardiac surgery has been widely studied in Brazil by Sá et al.[2], who evaluated several studies carried out over the last 30 years. The use of different antibiotics to the same end clearly indicates that there is no consensus on the efficacy and safety of each one[3]. Therefore, there is still no absolute certainty that the main antibiotics used effectively reach the tissues where infection occurs.
The objective of this study is to measure the concentration of cefazolin in the adipose tissue of the mediastinum in patients undergoing cardiac surgery in order to determine variation in cefazolin concentrations at the beginning and at the end of surgery.
METHODS
Location and Period of the Study
This study was conducted with 19 patients undergoing cardiac surgery at Dom Helder Câmara Hospital in Cabo de Santo Agostinho, Pernambuco, Brazil. The patients were operated in December 2015 and their summarized profile is presented in Table 1.
Table 1 Characteristics of the population.
[ Table Omitted - see PDF ]
Ethical Aspects
This research was approved by the Research Ethics Committee of the Health Sciences Center of Federal University of Pernambuco. This research follows the principles of the Helsinki Declaration for research on humans.
Inclusion Criteria
Patients over 18 years old who underwent cardiac surgery with cardiopulmonary bypass (CPB) [coronary artery bypass grafting (CABG) surgery, valve replacement, aortic aneurysm or multiple cardiac surgery] in which the access to the heart was through the sternum (sternotomy).
Exclusion Criteria
Patients requiring antibiotic prophylaxis other than cefazolin; patients with impaired renal function (creatinine > 1.5 mg/dl); patients who had low preoperative cardiac output with the use of vasoactive drugs.
Technical Procedures
All patients received an antibiotic regimen with cefazolin administered as follows: a first dose of 2g diluted in 100 ml saline at anesthesia induction, followed by a dose of 1g diluted...