Association between Surgical Site Infection and Prophylactic Antimicrobial Cefmetazole Sodium Dose and Renal Function in Laparoscopic Colon Resection Surgery

Prophylactic antimicrobial agents are administered to prevent surgical site infections (SSIs); guidelines recommend dosage and interval adjustment of prophylactic antimicrobial agents ac-cording to renal function to achieve adequate blood levels. Recently, it has been reported that the blood concentration of cefmetazole sodium (CMZ) is lower in patients with good renal function during lower gastrointestinal tract surgery, but there have been few reports on the relationship between renal function, CMZ dose, and the occurrence of SSI. We retrospectively investi-gated the relationship between SSI, CMZ dose used for prophylactic antimicrobial agents, and renal function in laparoscopic colon resections from January 2014 to August 2017. CMZ (1 g) was administered upon entry to the operating room and 3 h later. Patients who preoperatively used steroids, immunosuppressive agents, or antineoplastic agents, underwent hemodialysis, have BMI ≥ 25 kg/m 2 , have intraoperative blood loss ≥ 1500 mL, and have surgery time ＜ 180 min were excluded. A total of 98 patients were included in the analysis, 93 in the non-SSI group and 5 in the SSI group. A significant difference was observed in the individualized body surface area estimated glomerular filtration rate (eGFRind) between the non-SSI group (66.31 mL/min) and the SSI group (80.95 mL/min) (P = 0.01). A eGFRind cutoff value of 70.68 mL/min was calculated via ROC curve analysis (AUC = 0.841, specificity 67.7%, sensitivity 100%). Our findings suggest that 1 g of CMZ administered 3 h after surgery may be insufficient; the dose should be increased, or the interval between intraoperative additional doses should be shortened in patients with an eGFRind I ≥ 70.68 mL/min.