{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:17:58Z","timestamp":1783610278064,"version":"3.55.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"AHRQ)","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"name":"US Department of HHS)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current cefazolin prophylaxis guidelines recommend dose escalation from 2 to 3\u2005g in patients weighing \u2265120\u2005kg. However, body weight inconsistently reflects antibiotic distribution at the surgical site. This study evaluated whether computed tomography (CT)-derived body composition and kidney function better predict cefazolin concentrations at the surgical site than body weight alone in patients with obesity undergoing colorectal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective study of adults with obesity undergoing elective colorectal surgery who received cefazolin prophylaxis and had preoperative CT imaging. Cefazolin concentrations were measured in plasma, subcutaneous adipose tissue, and colorectal tissue during surgery. Computed tomography-derived body composition metrics were quantified using analytic morphomics. Modeling and simulations were used to identify predictors of target attainment in subcutaneous tissue. Agreement between revised physiologic dosing criteria and current weight-based guidance was assessed in both a derivation cohort and an independent external cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 153 patients, 58 were included in model development and 95 in prospective evaluation. Weight and body mass index (BMI) did not improve model performance. Subcutaneous fat area (SFA) predicted tissue exposure, while creatinine clearance (CLcr) predicted elimination. Current weight-based dosing achieved 78%\u201384% target attainment. A revised framework of SFA \u2265 500\u2005cm2 or \u2265300\u2005cm2 with CLcr \u2265 90\u2005mL\/min identified an additional 10%\u201314% of patients for dose adjustment, improving identification of underdosing-related surgical site infection (SSI) risk without unnecessary antibiotic use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cefazolin exposure is better explained by local adiposity and kidney function than by the current \u2265120\u2005kg weight-based dosing threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag383","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:43:49Z","timestamp":1781783029000},"source":"Crossref","is-referenced-by-count":0,"title":["Challenging Weight-Tiered Antibiotic Prophylaxis in Obese Patients Undergoing Colorectal Surgery Using Computed Tomography-Derived Body Composition"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7119-5034","authenticated-orcid":false,"given":"Manjunath P","family":"Pai","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2728-7103","authenticated-orcid":false,"given":"Aleksas","family":"Matvekas","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3051-9834","authenticated-orcid":false,"given":"June","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6627-4843","authenticated-orcid":false,"given":"Shuhan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2869-9584","authenticated-orcid":false,"given":"Brian","family":"Derstine","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1204-0790","authenticated-orcid":false,"given":"Brian","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9493-3497","authenticated-orcid":false,"given":"Hari","family":"Tummala","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Regenbogen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Byrn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8701-774X","authenticated-orcid":false,"given":"Grace L","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, University of Michigan , Ann Arbor, Michigan 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