The myth of the second prophylactic antibiotic dose in aortoiliac reconstructions

To determine whether a prophylactic second dose of antibiotics is justified when severe blood loss and/or prolonged operation time occurs during aortoiliac reconstructions. We measured the cefuroxime concentration in venous blood serum and subcutaneous fat tissue of 30 patients who underwent elective aortoiliac reconstruction after a single intravenous dose of 1500 mg cefuroxime. The mean blood loss was 1912 ml (range 200–7000). The mean operation time was 212 min (range 70–330). The cefuroxime concentration in blood serum 30 min after the gift varied from 53.7–561.6 mg/l and during closure of the abdominal incision from 13.2–90.0 mg/l. Taking the minimum inhibitory concentration for Staphylococcus species as 1.0 mg/l, we found an adequate prophylactic serum cefuroxime concentration in all patients. There was a statistically significant correlation between serum cefuroxime concentration and blood loss ( p = 0.01) and operation time ( p = 0.0001). Although serum concentration of cefuroxime is greatly influenced by blood loss and operation time, a second dose of cefuroxime in aortoiliac reconstructions is not necessary if the operation is completed within 5.5 h and if perioperative blood loss does not exceed 7000 ml.