Target-controlled infusion vs. standard dosing of cefoxitin for surgical prophylaxis in colorectal surgery: a randomized clinical trial.
Jong Lyul Lee, Ha-Jung Kim, Kyung Mi Kim et al.
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In 30 seconds
This single-centre, parallel-arm randomized clinical trial compared target-controlled infusion (TCI) with standard cefoxitin dosing for surgical prophylaxis in 2494 adults undergoing elective colorectal surgery. Surgical site infection within 30 days occurred in 5.6% of each group (69/1224 vs. 69/1233; relative risk 1.01; 95% CI 0.73-1.39), with no statistically significant difference. TCI was associated with lower intraoperative cefoxitin exposure: median dose 1.38 g versus 2.00 g with standard dosing. Acute kidney injury incidence also did not differ significantly.
Key findings
- SSI incidence was 5.6% with TCI and 5.6% with standard dosing (relative risk 1.01; 95% CI 0.73-1.39).
- Median intraoperative cefoxitin dose was 1.38 g with TCI versus 2.00 g with standard dosing (p < 0.001).
- Acute kidney injury occurred in 17.6% versus 15.7%, respectively, with no statistically significant difference (p 0.223; relative risk 1.12; 95% CI 0.94-1.34).
Why it matters
The trial found that a model-driven infusion strategy reduced intraoperative cefoxitin exposure without a detected difference in SSI incidence or acute kidney injury. These results inform evaluation of antibiotic delivery strategies in elective colorectal surgery, while the absence of a demonstrated SSI reduction means lower drug exposure should not be interpreted as improved infection prevention.
What to keep in mind
The trial was conducted at a single centre, limiting certainty about how well the findings generalize to other settings.