The effect of intraoperative excessive bleeding on the pharmacokinetics of ampicillin and sulbactam in recipients of living donor liver transplantation in Japan.

IF 3.3 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2025-08-26 eCollection Date: 2025-08-01 DOI:10.1093/jacamr/dlaf149
Yuji Wakimoto, Koh Okamoto, Takehito Yamamoto, Nobuhisa Akamatsu, Taro Kariya, Yoko Hoshino, Sohei Harada, Hideki Hashimoto, Daisuke Jubishi, Takehiro Tanaka, Ryo Yamaguchi, Junichi Kaneko, Shu Okugawa, Tappei Takada, Kiyoshi Hasegawa, Kanji Uchida, Takeya Tsutsumi
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引用次数: 0

Abstract

Objective: Guidelines recommend redosing with intravenous prophylactic antibiotics when excessive bleeding exceeds 1500 mL during surgery based on the pharmacokinetics data of cefazolin. However, the necessity for redosing of other antibiotics and the threshold volume of blood loss necessitating such supplementation remain undefined. We investigated plasma antibiotic concentrations during liver transplant surgery in patients with frequent excessive bleeding.

Methods: A single-centre, prospective, observational pharmacokinetic study was conducted. Adult liver transplant recipients who received 2 g of ampicillin and 1 g of sulbactam every 3 h during surgery were included. Blood samples were collected hourly during surgery, and intraoperative bleeding amounts were reviewed from anaesthesia records. Plasma concentrations of ampicillin and sulbactam were determined using validated liquid chromatography-tandem mass spectrometry. The probability of target attainment was set at 80% free time above the MIC (fT > MIC).

Results: Twenty participants were included. Of these, 11 participants (55%) were female. The median age, body weight, and bleeding volume were 52 years, 62.1 kg, and 11 158 mL, respectively. The intraoperative clearance of ampicillin was 80.28 mL/min, and sulbactam was 77.23 mL/min. The fT > MIC for both ampicillin and sulbactam tended to be lower with bleeding > 20 000 mL than with less bleeding. Plasma concentrations of ampicillin and sulbactam were maintained during surgery without redosing, even after bleeding exceeded 1500 mL.

Conclusions: Even with excessive bleeding, administering 3 g of ampicillin/sulbactam every 3 h maintained sufficient plasma concentration. Redosing may be unnecessary unless total bleeding exceeds 20 000 mL.

Abstract Image

Abstract Image

日本活体肝移植受者术中大出血对氨苄西林和舒巴坦药代动力学的影响。
目的:根据头孢唑林的药代动力学数据,指南推荐手术中大出血超过1500 mL时静脉预防性抗生素重新给药。然而,重新给药其他抗生素的必要性和需要这样补充的失血量的阈值仍不明确。我们调查了肝移植手术中频繁出血患者的血浆抗生素浓度。方法:采用单中心、前瞻性、观察性药代动力学研究。纳入手术期间每3小时给予2g氨苄西林和1g舒巴坦的成人肝移植受者。术中每小时采集一次血液样本,并从麻醉记录中回顾术中出血量。采用有效的液相色谱-串联质谱法测定氨苄西林和舒巴坦的血浆浓度。目标达成的概率设定在MIC以上80%的空闲时间(fT > MIC)。结果:共纳入20例受试者。其中,11名参与者(55%)是女性。中位年龄、体重和出血量分别为52岁、62.1 kg和11 158 mL。术中氨苄西林清除率80.28 mL/min,舒巴坦清除率77.23 mL/min。氨苄西林和舒巴坦的f> MIC在出血>20000ml时比出血较少时更低。手术期间维持氨苄西林和舒巴坦的血药浓度,无需再给药,即使出血超过1500 mL。结论:即使出血过多,每3小时给予3g氨苄西林/舒巴坦仍能维持足够的血药浓度。除非总出血超过20000毫升,否则不需要重新给药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
0.00%
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审稿时长
16 weeks
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