523. Risk of Fetal Exposure to Gentamicin Following Maternal Preoperative Prophylaxis for Cesarean Delivery
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek2013 JSetzerRev.pdf (310.6 kB)
  • Background:

    Missouri Baptist Medical Center is a 489 bed community hospital which had 4097 deliveries, 1499 by cesarean section in 2012. Administration of gentamicin in combination with clindamycin or metronidazole has been recommended by the American College of Obstetrics and Gynecology for preoperative prophylaxis for cesarean delivery in patients with penicillin allergy.  Concern has been expressed about the amount of antibiotic transferred transplacentally to the neonate prior to delivery as this could cause toxicity or affect therapeutic dosing should it become necessary to treat the neonate with gentamicin.  Known drug side effects include neurotoxicity manifested by ototoxicity and nephrotoxicity. Studies examining optimal gentamicin levels in neonates are limited, therefore acceptable concentrations must be inferred from adult data.  Therapeutic levels are defined as 6 -10 mcg/ml, with toxicity being 12 mcg/ml. The purpose of this study was to evaluate fetal exposure to gentamicin following preoperative cesarean prophylaxis with body weight adjusted doses of gentamicin given within 60 minutes prior to incision in non-emergent  cesarean section.  This was accomplished through cord blood sampling at delivery.

    Methods:

    Thirty penicillin allergic patients were enrolled from April 2012 to February 2013 to receive adjusted body weight dosing of prophylactic gentamicin. Cord blood was drawn post delivery for analysis.

    Results:

    Maternal weight ranged from 57.3 kg to 163.6 kg with preoperative prophylactic gentamicin dosing ranging from 80 to 140mg.  Gentamicin levels obtained from cord blood drawn 0 to 7 minutes post delivery ranged from <0.5 to 2.2 mcg/ml which is significantly below published acceptable levels.

    Conclusion:

    In this sample of 30 patients preoperative prophylaxis with gentamicin did not result in cord blood gentamicin levels that would interfere with neonatal treatment, or raise concern of gentamicin toxicity if therapy with this drug should become necessary.

    Janice Setzer, RN BSN CIC1, David Weinstein, MD FACOG2, Dennis Bouselli, PharmD2, Jeffrey Dawson, MD3, Emily Petersen, RN BSN2, Christine Dohogne, RN BSN2, Deanna Elijah-Woodside, RN MSN MHA2, Jeanne Zack, PhD RN CIC1 and Erik Dubberke, MD, MSPh4, (1)Infection Prevention and Control, Missouri Baptist Medical Center, St Louis, MO, (2)Missouri Baptist Medical Center, St Louis, MO, (3)Washington University - Department of Pediatrics, St Louis, MO, (4)Infectious Disease, Washington University School of Medicine, St. Louis, MO

    Disclosures:

    J. Setzer, None

    D. Weinstein, None

    D. Bouselli, None

    J. Dawson, None

    E. Petersen, None

    C. Dohogne, None

    D. Elijah-Woodside, None

    J. Zack, None

    E. Dubberke, Merk: Consultant and Investigator, Consulting fee and Research support
    Viropharma : Investigator, Research support
    Optimer: Consultant and Investigator, Consulting fee and Research support
    Pfizer : Consultant, Consulting fee
    Sanofi Pasteur: Investigator, Research support
    bioMerieux: Consultant, Consulting fee

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