Continuous v Bolus Infusion of Cefazolin During Ventral Hernia Repair

NCT ID: NCT02666365

Last Updated: 2018-05-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2018-03-31

Study Completion Date

2019-06-30

Brief Summary

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Patients undergoing an elective ventral hernia repair will be randomly assigned to receive either bolus infusion or continuous infusion of the cefazolin as the prophylactic antibiotic. The blood concentrations of unbound cefazolin would be measured in their blood samples and the levels compared within the two groups with respect to their minimal inhibitory concentration (MIC) value.

Detailed Description

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Patients who will be undergoing elective ventral hernia repair will be potential candidates for this study. Once identified, the surgical team will approach the participant for consent and inclusion in the study. On the day of surgery, the subjects will be assigned to either the Bolus Group (CB) or Continuous Infusion Group (CI) according to a randomly generated assignment procedure. During the procedure, the dose of prophylactic Cefazolin will be given an hour before surgery and will be administered in accordance to group assignment. Subjects in the CB will receive bolus infusions of Cefazolin every 4 hours till the end of surgery. Subjects in the CI group will receive an initial bolus injection of Cefazolin followed by a continuous infusion till the closure of skin incision. Blood samples will be taken during surgery at t=0, 15, 30 and 60 minutes and every hour following till the end of surgery or 6 hours (whichever comes sooner)

Conditions

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Surgical Site Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Bolus infusion of Cefazolin

Subjects undergoing a ventral hernia repair in this arm of the study will receive the surgical prophylactic, cefazolin, in a bolus infusion

Group Type ACTIVE_COMPARATOR

Bolus infusion of Cefazolin

Intervention Type PROCEDURE

Subjects in the bolus infusion arm of the study will receive bolus infusions of cefazolin throughout the surgical procedure

Continuous Infusion of Cefazolin

Subjects undergoing a ventral hernia repair in this arm of the study will receive the surgical prophylactic, cefazolin, in a continuous infusion

Group Type ACTIVE_COMPARATOR

Continuous infusion of Cefazolin

Intervention Type PROCEDURE

Subjects in the continuous infusion arm of the study will receive a continuous infusion of the cefazolin throughout the surgical procedure

Interventions

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Bolus infusion of Cefazolin

Subjects in the bolus infusion arm of the study will receive bolus infusions of cefazolin throughout the surgical procedure

Intervention Type PROCEDURE

Continuous infusion of Cefazolin

Subjects in the continuous infusion arm of the study will receive a continuous infusion of the cefazolin throughout the surgical procedure

Intervention Type PROCEDURE

Other Intervention Names

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Bolus infusion Continuous infusion

Eligibility Criteria

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Inclusion Criteria

* Age \>18 years
* Elective open Ventral hernia repair in CDC class one (clean) cases
* Planned operative time greater than 4 Hours
* Planned routine administration of cefazolin for pre-op prophylaxis
* No history of MRSA

Exclusion Criteria

* Patients unable to give informed consent
* Allergy to cephalosporins
* Pre-existing documented infection or ostomy (class II-IV wounds)
* Received cefazolin within 24 hours before surgery
* Creatinine clearance \< 30 ml/min
* Upstaging of wound class intra-op that results in the administration of additional antibiotics
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Milton S. Hershey Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Kunal Karamchandani

Assistant Professor of Anesthesiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Kunal Karamchandani, MD

Role: PRINCIPAL_INVESTIGATOR

Milton S. Hershey Medical Center

References

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MILES AA, MILES EM, BURKE J. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol. 1957 Feb;38(1):79-96. No abstract available.

Reference Type BACKGROUND
PMID: 13413084 (View on PubMed)

Lee FM, Trevino S, Kent-Street E, Sreeramoju P. Antimicrobial prophylaxis may not be the answer: Surgical site infections among patients receiving care per recommended guidelines. Am J Infect Control. 2013 Sep;41(9):799-802. doi: 10.1016/j.ajic.2012.11.021. Epub 2013 Mar 13.

Reference Type BACKGROUND
PMID: 23489739 (View on PubMed)

Hawn MT, Vick CC, Richman J, Holman W, Deierhoi RJ, Graham LA, Henderson WG, Itani KM. Surgical site infection prevention: time to move beyond the surgical care improvement program. Ann Surg. 2011 Sep;254(3):494-9; discussion 499-501. doi: 10.1097/SLA.0b013e31822c6929.

Reference Type BACKGROUND
PMID: 21817889 (View on PubMed)

Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA. 2010 Jun 23;303(24):2479-85. doi: 10.1001/jama.2010.841.

Reference Type BACKGROUND
PMID: 20571014 (View on PubMed)

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists (ASHP); Infectious Diseases Society of America (IDSA); Surgical Infection Society (SIS); Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013 Feb;14(1):73-156. doi: 10.1089/sur.2013.9999. Epub 2013 Mar 5. No abstract available.

Reference Type BACKGROUND
PMID: 23461695 (View on PubMed)

Adembri C, Ristori R, Chelazzi C, Arrigucci S, Cassetta MI, De Gaudio AR, Novelli A. Cefazolin bolus and continuous administration for elective cardiac surgery: improved pharmacokinetic and pharmacodynamic parameters. J Thorac Cardiovasc Surg. 2010 Aug;140(2):471-5. doi: 10.1016/j.jtcvs.2010.03.038. Epub 2010 Jun 8.

Reference Type BACKGROUND
PMID: 20570290 (View on PubMed)

Trent Magruder J, Grimm JC, Dungan SP, Shah AS, Crow JR, Shoulders BR, Lester L, Barodka V. Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections During Cardiac Surgical Procedures: A Propensity-Matched Analysis. J Cardiothorac Vasc Anesth. 2015 Dec;29(6):1582-7. doi: 10.1053/j.jvca.2015.03.026. Epub 2015 Mar 31.

Reference Type BACKGROUND
PMID: 26275516 (View on PubMed)

Ferraz AA, Siqueira LT, Campos JM, Araujo GC, Martins Filho ED, Ferraz EM. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem. Arq Gastroenterol. 2015 Apr-Jun;52(2):83-7. doi: 10.1590/S0004-28032015000200002.

Reference Type BACKGROUND
PMID: 26039823 (View on PubMed)

Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005 Nov;190(5):676-81. doi: 10.1016/j.amjsurg.2005.06.041.

Reference Type BACKGROUND
PMID: 16226938 (View on PubMed)

Dunne JR, Malone DL, Tracy JK, Napolitano LM. Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res. 2003 May 1;111(1):78-84. doi: 10.1016/s0022-4804(03)00077-5.

Reference Type BACKGROUND
PMID: 12842451 (View on PubMed)

Houck JP, Rypins EB, Sarfeh IJ, Juler GL, Shimoda KJ. Repair of incisional hernia. Surg Gynecol Obstet. 1989 Nov;169(5):397-9.

Reference Type BACKGROUND
PMID: 2530641 (View on PubMed)

Kaafarani HM, Kaufman D, Reda D, Itani KM. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res. 2010 Oct;163(2):229-34. doi: 10.1016/j.jss.2010.03.019. Epub 2010 Apr 1.

Reference Type BACKGROUND
PMID: 20605590 (View on PubMed)

Blatnik JA, Krpata DM, Novitsky YW, Rosen MJ. Does a history of wound infection predict postoperative surgical site infection after ventral hernia repair? Am J Surg. 2012 Mar;203(3):370-4; discussion 374. doi: 10.1016/j.amjsurg.2011.12.001.

Reference Type BACKGROUND
PMID: 22364903 (View on PubMed)

Buijk SE, Gyssens IC, Mouton JW, Metselaar HJ, Groenland TH, Verbrugh HA, Bruining HA. Perioperative pharmacokinetics of cefotaxime in serum and bile during continuous and intermittent infusion in liver transplant patients. J Antimicrob Chemother. 2004 Jul;54(1):199-205. doi: 10.1093/jac/dkh268. Epub 2004 Jun 2.

Reference Type BACKGROUND
PMID: 15175266 (View on PubMed)

Other Identifiers

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STUDY00003845

Identifier Type: -

Identifier Source: org_study_id

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