TY - JOUR
T1 - Effect of maternal obesity on Maternal-Fetal transfer of preoperative cefazolin at cesarean section
AU - Groff, Stephanie Mckenney
AU - Fallatah, Wareef
AU - Yang, Samuel
AU - Murphy, Jamie
AU - Crutchfield, Christopher
AU - Marzinke, Mark
AU - Kurtzberg, Joanne
AU - Lee, Carlton K.K.
AU - Burd, Irina
AU - Azadeh, Farzin
N1 - Funding Information:
The study was supported by the Gerber Foundation, the Thrasher Research Fund, Thomas Wilson Sanitarium for Children of Baltimore City, The Johns Hopkins (KL2) Mentored Career Development Award, National Institute of Child Health and Human Development (NICHD; K08 HD 073315), The Dr. Sydney H. Kane, Emma B. Kane, David M. Kane and Family Endowment Fund, and The Sheila S. and Lawrence C. Pakula, M.D., Endowment for Neonatal Research. A portion of this manuscript was presented at the Society for Maternal-Fetal Medicine (SMFM) 2015 Annual Meeting in San Diego, California.
Publisher Copyright:
© Published by the Pediatric Pharmacy Advocacy Group. All rights reserved.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - OBJECTIVES American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis. METHODS Maternal and fetal cefazolin plasma concentrations were compared between obese (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI < 25 kg/m2) healthy, term pregnant women undergoing scheduled C/S. Liquid chromatographic–tandem mass spectrometric (LC-MS/MS) methods were used for quantification of total and free cefazolin concentrations in maternal blood (MB) and umbilical cord blood (UCB). RESULTS Eight women were screened and consented. There was no difference between groups in MB total and free cefazolin concentrations. All MB samples had total and free cefazolin concentrations greater than the minimum inhibitory concentration 90 (MIC90) for Group B Streptococcus (GBS), Staphylococcus aureus, and Escherichia coli. All UCB samples had total and free cefazolin concentrations greater than MIC90 for GBS and S aureus, even when administered as briefly as 18 minutes before delivery. A lower concentration of total cefazolin was detected in UCB of neonates of obese women compared to non-obese women (p > 0.05).CONCLUSIONS Administration of 2 g of cefazolin to women undergoing scheduled C/S might be an adequate prophylactic dose for surgical wound infection in both non-obese and obese patients; and cefazolin concentration in fetal circulation may be protective against GBS and S aureus.
AB - OBJECTIVES American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis. METHODS Maternal and fetal cefazolin plasma concentrations were compared between obese (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI < 25 kg/m2) healthy, term pregnant women undergoing scheduled C/S. Liquid chromatographic–tandem mass spectrometric (LC-MS/MS) methods were used for quantification of total and free cefazolin concentrations in maternal blood (MB) and umbilical cord blood (UCB). RESULTS Eight women were screened and consented. There was no difference between groups in MB total and free cefazolin concentrations. All MB samples had total and free cefazolin concentrations greater than the minimum inhibitory concentration 90 (MIC90) for Group B Streptococcus (GBS), Staphylococcus aureus, and Escherichia coli. All UCB samples had total and free cefazolin concentrations greater than MIC90 for GBS and S aureus, even when administered as briefly as 18 minutes before delivery. A lower concentration of total cefazolin was detected in UCB of neonates of obese women compared to non-obese women (p > 0.05).CONCLUSIONS Administration of 2 g of cefazolin to women undergoing scheduled C/S might be an adequate prophylactic dose for surgical wound infection in both non-obese and obese patients; and cefazolin concentration in fetal circulation may be protective against GBS and S aureus.
KW - Antibiotic prophylaxis
KW - Cefazolin
KW - Obesity
KW - Pregnancy
KW - Surgical wound infection
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U2 - 10.5863/1551-6776-22.3.227
DO - 10.5863/1551-6776-22.3.227
M3 - Article
C2 - 28638306
AN - SCOPUS:85041004980
SN - 1551-6776
VL - 22
SP - 227
EP - 232
JO - Journal of Pediatric Pharmacology and Therapeutics
JF - Journal of Pediatric Pharmacology and Therapeutics
IS - 3
ER -