Peri-operative Cefazolin Prophylaxis at Time of Cesarean Delivery in the Obese Gravida
Study Details
Study Description
Brief Summary
Obesity has become an increasingly prevalent public health problem in the United States, reaching epidemic proportions. According to 2009 CDC epidemiologic data on obesity in the United States, 35.7% of the United States population is considered overweight or obese. Currently, on the review of the literature, over 20% of pregnancies in this country are complicated by maternal obesity. Obesity has been well demonstrated to be correlated with numerous adverse pregnancy outcomes such hypertensive disorders of pregnancy, gestational diabetes, and increased rates of operative delivery. Moreover, obesity, irrespective of pregnancy, has been demonstrated to be an independent risk factor for the development of postoperative surgical site infections. Development of such infections can have both consequential long-term medical sequelae for patients and economic impacts on the health care system at large. Cefazolin, a first generation hydrophilic cephalosporin whose clearance is exclusively mediated via the kidneys unchanged, is used as pre-operative antibiotic prophylaxis for cesarean deliveries. The current accepted standard of care is to administer 2 grams of cefazolin within 60 minutes of skin incision. Studies of drug concentrations of cephalosporins for pre-operative antibiotic prophylaxis in obese bariatric patients have shown that therapeutic concentrations may not be achieved in both tissue and plasma. Limited data exist in pregnancy. Therefore, it is the goal of this study to investigate whether obese patients presenting for cesarean delivery require an increased dosing amount of pre-operative antibiotic prophylaxis. This study will randomized women with a pre-pregnancy body mass index of 30 kg/m2 or more who are presenting for their scheduled cesarean delivery to receive either 2 grams or 3 grams of cefazolin for pre-operative antibiotic prophylaxis. By drawing blood at specific time points in the peri-operative period and extracting adipose tissue samples during cesarean delivery, this study will investigate the pharmacokinetics of cefazolin in both the plasma and tissues of the obese gravida.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Cefazolin 2 grams
|
Drug: Pre-operative cefazolin
|
| Active Comparator: Cefazolin 3 grams
|
Drug: Pre-operative cefazolin
|
Outcome Measures
Primary Outcome Measures
- Plasma area under the curve (AUC) of cefazolin [Within the first 8 hours after skin incision]
The primary aim of this study will be to evaluate the plasma area under the curve (AUC) of cefazolin in both the 2 grams and 3 grams groups. Blood samples will be obtained prior to administration of cefazolin and then 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes, 4 hours, 6 hours and 8 hours from administration of cefazolin
Secondary Outcome Measures
- Adipose tissue concentrations of cefazolin [Adipose tissue samples will be assessed at time of skin incision, hysterotomy closure and then fascial closure.]
- Cmax [Within the first 8 hours after skin incision]
- Drug Clearance (Cl) [Within the first 8 hours after skin incision]
- Volume of distribution (Vd) [Within the first 8 hours after skin incision]
- Absolute drug concentrations in plasma and tissue [Within the first 8 hours after skin incision]
- Tissue to Plasma (T/P) Drug Concentration Ratios [Within the first 8 hours after skin incision]
- Surgical site infection fo any type [Participants will be followed for the duration of their hospital stay and will be called at 6 weeks from surgery]
- Cord blood concentration [At time of delivery]
- Urine drug concentration [8 hours]
Samples to be obtained up to 8 hours post cesarean delivery
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Body mass index (BMI) greater than 30kg/m2
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Those women having scheduled primary or repeat cesarean delivery
Exclusion Criteria:
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Type 1 and Type 2 Insulin Dependent Diabetes Mellitus
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Autoimmune disease, including systemic lupus erythematosus
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History of chronic renal disease
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Those using chronic corticosteroids
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Those with a history of a previous wound breakdown
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Those who have an allergy to cephalosporins whose reaction includes anaphylaxis, urticaria or other systemic consequences
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Those who are unable to receive their antibiotics in a timely fashion
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Magee-Women's Hospital/University of Pittsburgh Medical Center | Pittsburgh | Pennsylvania | United States | 15213 |
Sponsors and Collaborators
- University of Pittsburgh
Investigators
- Principal Investigator: Omar Young, MD, Clinical Fellow, Division of Maternal-Fetal Medicine
Study Documents (Full-Text)
None provided.More Information
Publications
- ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011 Jun;117(6):1472-1483. doi: 10.1097/AOG.0b013e3182238c31.
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