Serum Concentration of CEFOxitin Used for Antibiotic Prophylaxis in Obese Patients Undergoing BARiatric Surgery
Serum Concentration of CEFOxitin Used for Antibiotic Prophylaxis in Obese Patients Undergoing BARiatric Surgery
Obesity is a pandemic problem in modern societies. Bariatric surgery (gastric by-pass and
 sleeve gastrectomy) has emerged as an efficient treatment to reduce morbidity and mortality
 related to obesity. Obesity and bariatric surgery are known to be risk factors of surgical
 site infections (SSI). The occurrence of SSI increases health cost and the duration of
 hospitalization. However, an appropriate antibiotic prophylaxis has been shown to reduce SSI.
 As recommended by several national societies, the antibiotic prophylaxis dose should be
 increased in the severely obese population. However, this recommendation lies on a low level
 of evidence. Besides, great disparities regarding obese patient antibiotic prophylaxis exist
 between countries and adequate doses are still not clearly defined. In France, for instance,
 the intravenous second generation cephalosporin CEFOXITIN is used for antibiotic prophylaxis
 in bariatric surgery at the initial loading dose of 4g (2-fold that of non-obese population)
 at the beginning of surgery.

 Obese patients have increased risk of under-dosage due to modification of their
 pharmacokinetics (fat/lean mass, distribution volume, renal clearance, etc.). Only few
 studies, all investigating a low amount of patients, evaluated the appropriateness of
 intraoperative antibiotic prophylaxis dosage of different betalactam and cephalosporin in the
 obese population. This population was more likely to be under-dosed.

 The aim of this study is to analyse the appropriateness of the reference dose of intravenous
 Cefoxitin used as antibiotic prophylaxis in severely obese patients undergoing bariatric
 surgery. This will be a 2-year prospective monocentric study held in the University Hospital
 of Nancy, France. A large group of obese patients (~300) will be included. Serial serum
 concentration measurements of Cefoxitin will be performed before, during, and at skin closure
 of the bariatric surgery. This study will give insights in pharmacokinetics of the antibiotic
 prophylaxis in the obese population and will help to determine the initial dosage and the
 optimal method for antibiotic prophylaxis administration.
Inclusion Criteria:

 -  Age ≥ 18 years-old,

 -  Severely obese patient with a BMI ≥ 35 kg.m-2,

 -  Scheduled bariatric surgery: gastric by-pass or sleeve gastrectomy,

 -  Affiliated to social security,

 -  The patient is able to consent to clinical research and has received all information
 on the study design/protocol,

 -  Signed/written informed consent

 Exclusion Criteria:

 -  Refuse to consent to the study or the patient is unable to consent,

 -  Allergy/Anaphylaxis to beta-lactam (ß-lactam) antibiotics either proven or suspected,

 -  Pregnancy,

 -  Persons deprived of their liberty by judicial or administrative decision,

 -  Urgent or emergent surgery.