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Ann Thorac Surg 2005;80:383-384
© 2005 The Society of Thoracic Surgeons

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Correspondence

Weight as a Risk Factor of Mediastinitis After Cardiac Surgery in Context of Insufficient Dosage of Prophylactic Antibiotic

^a Hôpital Louis Pradel, 28 Avenue Doyen Lépine, Bron Cedex, 69677 France
^b Hôpital Edouard Herriot, 5 Place d’Arsonval, Lyon Cedex 03, 69437 France

(Email: jacqueline.grando{at}chu-lyon.fr).

To the Editor:

Abboud and colleagues [1] showed that obesity was an independent risk factor for postsurgical mediastinitis and suggested that an inappropriate dose of prophylactic antibiotic for high body weight may facilitate this complication.

At the Louis Pradel Hospital, operative site infections after cardiopulmonary bypass (CPB) operations have been continuously surveyed since 1988, and the incidence rate of mediastinitis ranged from 0.4% to 1%. Seven cases of mediastinitis occurred between February 11, 2002 and March 19, 2002 corresponding to an attack rate of 2.8%. A case-control study performed and interpreted using multiple logistic regression revealed that weight was the only variable associated with mediastinitis (median weight of cases, 85 kg; range, 66 to 95; median weight of controls, 65.5 kg; range, 48 to 80 [p = 0.001]; odds ratio, 1.24; 95% confidence interval, 1.02 to 1.49). After stratification on median of weight (75 kg), the adjusted odds ratio for mediastinitis was 21.0 (95% confidence interval, 1.77 to 248.10) for patients with a weight > 75 kg.

The resurgence of mediastinitis occurred after a modification of antibiotic prophylaxis, which was made to comply with the official French recommendations [2] in the absence of any other pertinent changes to procedures or treatments. Before January 2002 the regimen was cefazolin 2g before incision followed by 1g/8 hr for 24 hours, in combination with gentamicin 2 mg/kg before incision followed by 1.5 mg/kg/8 hr for 24 hours. After January 2002, the body-weight adjusted gentamicin was discontinued. We hypothesized that the new regimen based on a single molecule with no weight adjustment could lead to insufficient antibiotic concentration for heavy patients. Thus, an adjustment to the patient weight was introduced in April 2002; patients weighing > 70 Kg were given cefazolin 2g before incision followed by an increased dose of 2g/8 hr for 24 hours. During the following 24 months (until July 2004), the incidence of mediastinitis was < 1%, as before the modifications were introduced. This study confirms the hypothesis of Abboud and colleagues [1] and reasserts the importance of adjusting the dose of prophylactic antibiotics for patients’ body mass.

	References

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1. Abboud CS, Wey SB, Baltar VT. Risk factor for mediastinitis after cardiac surgery Ann Thorac Surg 2004;77:676-683.[Abstract/Free Full Text]
2. Société Française d’Anesthésie Réanimation. Recommandations pour la pratique de l’antibioprophylaxie en chirurgie. La Lettre de l’Infectiologue 14:205–13..

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Grando, J. Articles by Vandenesch, F. Search for Related Content PubMed Articles by Grando, J. Articles by Vandenesch, F. Related Collections Chest wall Related Article