{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:59:24Z","timestamp":1780088364046,"version":"3.54.0"},"reference-count":57,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Advancing Queensland Clinical Fellowship"},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP2007007"],"award-info":[{"award-number":["APP2007007"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP3009736"],"award-info":[{"award-number":["APP3009736"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sunshine Coast Hospital and Health Service Study, Education and Research Trust Fund (SERTF) Open Access Publishing Fees Funding Scheme"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Cefazolin is commonly administered for surgical antibiotic prophylaxis. This review aims to examine whether target unbound plasma and tissue cefazolin concentrations are reached following prophylactic administration across multiple surgical subtypes. The primary outcome was a lower limit of cefazolin concentration variability (mean\u2013SD, lower quartile, or lower range) in unbound plasma and\/or tissue &gt; 2 mg\u00b7L\u22121, the epidemiological cut-off (ECOFF) value for Staphylococcus aureus at skin incision and\/or closure. Methods: Prisma 2020 guidelines were followed, and the protocol is registered in PROSPERO (CRD42021080289). A literature search using MEDLINE (PubMed), Embase, CENTRAL, CINAHL, and further databases was performed to identify studies in which prophylactic cefazolin was administered to adult surgical patients (\u226518 years old) undergoing elective surgery, and unbound plasma and tissue concentrations were measured at skin incision and closure. Exclusion criteria included languages other than English, emergency surgery, cefazolin being administered for any reason other than surgical site prophylaxis, and whether patients received any cefazolin within the 48 h prior to the prophylactic dose. The search was repeated in August 2025 to ensure currency. A narrative assessment of the methodological quality was performed. The data were synthesised in a narrative and tabular form, and the certainty of the evidence was assessed using the GRADE approach. Results: A total of 37 studies with 1102 patients met the inclusion criteria. Twelve bariatric studies and 378 patients, 9 cardiac studies and 197 patients, 8 obstetric studies and 277 patients, 6 orthopaedic studies and 176 patients, 3 abdominal surgery studies and 62 patients, and 1 vascular study and 12 patients were included. Two studies met the inclusion criteria for both bariatric and abdominal surgery. The lower limit of variability of the unbound plasma concentration was consistently &gt;2 mg\u00b7L\u22121. The reported lower limits of variability in tissue concentrations of bariatric surgery were conflicting. Only one study in cardiac surgery assessed the current dosing regimens. The lower range of variability of tissue concentrations was consistently &gt;2 mg\u00b7L\u22121 in the orthopaedic, obstetric, abdominal, and vascular surgery subtypes. Conclusions: The current dosing approaches in the obstetric, orthopaedic, abdominal, and vascular surgery groups are reassuring for achieving effective concentrations, although the overall data are sparse. It is unclear if increased dosing is warranted in bariatric surgery patients, and further investigations in cardiac surgery with current dosing regimens are required.<\/jats:p>","DOI":"10.3390\/antibiotics14121227","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:37:02Z","timestamp":1764952622000},"page":"1227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Peri-Operative Dosage and Therapeutic Concentrations of Cefazolin Administered for Surgical Site Infection Prophylaxis in Elective Surgery\u2014A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4483-6398","authenticated-orcid":false,"given":"Rochelle","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Peri-Operative Medicine, Sunshine Coast Health, Birtinya, QLD 4575, Australia"},{"name":"School of Medicine, The University of Queensland, Herston, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-2614","authenticated-orcid":false,"given":"Cemre","family":"Bosnak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Hospital, Ankara 06230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bright","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesa","family":"Cheng","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia"},{"name":"Medical Education Unit, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia"},{"name":"Department of Anaesthesia and Intensive Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong 999077, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Velli","sequence":"additional","affiliation":[{"name":"Library and Information Management, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"van Zundert","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Queensland, Herston, QLD 4029, Australia"},{"name":"Department of Anaesthesia and Peri-Operative Medicine, The Royal Brisbane and Women\u2019s Hospital, Herston, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5965-9876","authenticated-orcid":false,"given":"Jeffrey","family":"Lipman","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia"},{"name":"UR UM 103, Division of Anesthesia, Critical Care and Emergency and Pain Medicine, Nimes University Hospital, University of Montpellier, 30029 Nimes, France"},{"name":"Herston Infectious Disease Institute (HeIDI), Metro North Health, Herston, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Roberts","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia"},{"name":"UR UM 103, Division of Anesthesia, Critical Care and Emergency and Pain Medicine, Nimes University Hospital, University of Montpellier, 30029 Nimes, France"},{"name":"Herston Infectious Disease Institute (HeIDI), Metro North Health, Herston, QLD 4029, Australia"},{"name":"Departments of Intensive Care Medicine and Pharmacy, The Royal Brisbane and Women\u2019s Hospital, Herston, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13756-019-0570-y","article-title":"The Prevalence of Healthcare Associated Infections among Adult Inpatients at Nineteen Large Australian Acute-Care Public Hospitals: A Point Prevalence Survey","volume":"8","author":"Russo","year":"2019","journal-title":"Antimicrob. 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