358. Three's a Crowd: An Evaluation of Efficacy and Safety of Cefazolin 3g versus Cefazolin 2g for Surgical Prophylaxis in Obese Patients
Session: Poster Abstract Session: HAI: Surgical Site Infections
Thursday, October 8, 2015
Room: Poster Hall
Background: Recent clinical practice guidelines for antimicrobial surgical prophylaxis recommend a more aggressive weight-based dosing scheme for obese patients scheduled to receive cefazolin. Despite the lack of robust clinical data, many institutions, including our own, adopted these practices due to cefazolin’s favorable safety profile and relatively low cost.  We sought to evaluate the efficacy and safety of preoperatively administered cefazolin 2g versus cefazolin 3g in patients weighing > 120 kg.

Methods: We performed a single-center, pre- and post-intervention retrospective analysis of all patients weighing >120 kg receiving perioperative cefazolin 2g between April to December, 2012, and compared it to patients receiving cefazolin 3g from April to December 2013.   Patients were excluded if they did not receive perioperative cefazolin per national guidelines, which included indication and timing of antibiotic administration.  The primary outcome was the number of surgical site infections (SSI), as defined by the U.S. Centers for Disease Control’s National Healthcare Safety Network, between the two groups.  Secondary outcomes included postoperative adverse drug reactions within 72 hours and number of Clostridium difficile infections (CDI) within 3 months of receiving cefazolin.

Results: A total of 711 patients were included: 380 patients in the 2g group, 331 patients in the 3g group.  Baseline characteristics were similar between the two groups, with the exception of weight (138 kg vs 135.3 kg; p=0.026), urological procedures (11.6% vs 3.6%; p < 0.001) and cardiothoracic procedures (2.1% vs 6.6%; p=0.004).  No significant difference was found in the rate of SSI (0.016 vs 0.003; p=0.120).  Similarly, there were no significant differences in the number of CDI cases (0 vs 2; p=0.250) or documented adverse reactions (16.6% vs 16.9%; p=0.920), with the most common reaction being gastrointestinal in nature.

Conclusion: Our analysis demonstrates that there is no significant difference in the rate of SSI between cefazolin 2g and 3g doses administered in patients weighing > 120 kg.  Additionally, there is no significant difference in postoperative adverse drug reactions and cases of CDI.

Mary Staicu, Pharm.D.1, Leanna Liu, Pharm.D.2, Maryrose Laguio, MD3, Mary Lourdes Brundige, PharmD2 and Alexandra Yamshchikov, M.D.4, (1)Pharmacy, Rochester Regional Health, Rochester, NY, (2)Pharmacy, Rochester General Hospital, Rochester, NY, (3)Infectious Disease, Rochester General Hospital, Rochester, NY, (4)Infectious Diseases, Rochester General Health System, Rochester, NY


M. Staicu, None

L. Liu, None

M. Laguio, None

M. L. Brundige, None

A. Yamshchikov, None

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