Antibiotics Distribution Study in Peripheral Compartments: Contribution of Microdialysis

Официальное название

Cefazolin Distribution in Mediastinum After Heart Surgery in Children Using a Microdialysis Probe.

Обзор

Postoperative mediastinitis is an important cause of postoperative morbidity in children. The main objective of this study is to describe the distribution of cefazolin, using as surgical antibiotic prophylaxis, in the mediastinal compartment in children after cardiac surgery for congenital heart disease. The investigators aims to build a population pharmacokinetic model of cefazolin using plasma and tissue concentrations in order to optimize and individualize cefazolin dosing regimens. Cefazolin tissue pharmacokinetics will use a microdialysis procedure.

Подробное описание

Children with congenital heart disease are very fragile during the postoperative period and at risk of life-threatening mediastinitis due to various factors: post-extracorporeal circulation inflammation, frequent organ failure, possible delayed thorax closure. These patients are at risk of unpredictable pharmacokinetics alteration and inter-individual variability of the drug tissue: significant fluid intake, drug metabolism and elimination functions alteration, extracorporeal circulation. The effective prevention of postoperative mediastinitis in this population is therefore a major issue and challenge. Studying the distribution of cefazolin in the mediastinum and identifying the factors of inter-individual variability would improve the prevention of this pathology by optimizing the dosing.

During cardiac surgery, a microdialysis probe is placed by the surgeon in the mediastinum. The outgoing fluid will be collected every 30 minutes to every 2 hours, for approximately 28 hours. Six plasma samples will be drawn over these 28 hours to measure plasma concentrations. The probe's recovery will then be calculated and the probe will be removed up to 36 hours after insertion.

Вмешательства

• Процедура Microdialysis probe placement
  Microdialysis probe is placed at the end of cardiac surgery in mediastinum and used during 36 hours for tissue samples until withdrawal.
• Процедура Microdialysis and Plasma samples
  26 Cefazolin Free tissue concentrations 6 total plasma concentrations

Первичные конечные точки

• Total clearance [Срок оценки: 36 hours]
• Distribution volume [Срок оценки: 36 hours]
• Inter-compartmental clearance [Срок оценки: 36 hours]

Вторичные конечные точки (2)

• Monte Carlo simulations and dosing optimization [Срок оценки: 36 hours]
• post-operative mediastinitis occurrence [Срок оценки: Month 1]

Критерии участия

Критерии включения

• Child aged over 6 months and under 6 years
• Hospitalized in pediatric cardiac intensive care after cardiac surgery for congenital heart disease.
• Selected congenital heart diseases: ventricular septal defect auricular septal defect, pulmonary stenosis, tetralogy of Fallot
• Surgery with median sternotomy and intraoperative cardiopulmonary bypass
• Intraoperative antibiotic prophylaxis with cefazolin
• Patient affiliated with a social security plan or eligible
• whose two parents or legal guardians have accepted and signed the study consent

Критерии исключения

• Emergency cardiac surgery
• Patient already enrolled in the study
• Patient who has previously undergone cardiac surgery
• Patient with haemostasis disorders or immune deficiency
• Patient with bacterial colonization indicating antibiotic prophylaxis other than cefazolin
• Participation in another interventional research study

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Фундаментальное исследование

Центры проведения

Франция · 1 центр

• Hôpital Necker Enfants Malades — Paris

Публикации

• Himebauch AS, Sankar WN, Flynn JM, Sisko MT, Moorthy GS, Gerber JS, Zuppa AF, Fox E, Dormans JP, Kilbaugh TJ. Skeletal muscle and plasma concentrations of cefazolin during complex paediatric spinal surgery. Br J Anaesth. 2016 Jul;117(1):87-94. doi: 10.1093/bja/aew032. PMID 27317707
• Andreas M, Zeitlinger M, Wisser W, Jaeger W, Maier-Salamon A, Thalhammer F, Kocher A, Hiesmayr JM, Laufer G, Hutschala D. Cefazolin and linezolid penetration into sternal cancellous bone during coronary artery bypass grafting. Eur J Cardiothorac Surg. 2015 Nov;48(5):758-64. doi: 10.1093/ejcts/ezu491. Epub 2014 Dec 18. PMID 25527166

Идентификаторы

NCT: NCT07327502 · APHP241591 · 2025-521988-13

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗