Objective: Prospective studies show a 10% incidence of sternal wound infection (SWI) after 90 days of followup, compared with infection rates of 5% reported by the National Nosocomial Infections Surveillance System after only 30 days of follow-up. This incidence increases 2-3 times in high-risk patients. Design: Prospective randomised double-blind controlled clinical trial. Setting: Cardiothoracic centre, UK. Patients: Patients were eligible if they were undergoing median sternotomy for primary isolated coronary artery bypass grafting, with at least one internal thoracic artery used for coronary grafting and having one or more of the following three risk factors: (1) obesity, defined as body mass index 30 kg/m 2 ; (2) diabetes mellitus; or (3) bilateral internal thoracic artery grafts (ie, the use of the other internal thoracic artery). Interventions: The study group received a single dose of gentamicin 2 mg/kg, rifampicin 600 mg and vancomycin 15 mg/kg, with three further doses of 7.5 mg/kg at 12-hour intervals. The control group received cefuroxime 1.5 g at induction and three further doses of 750 mg at 8-hour intervals. Main outcome measures: The primary end point was the incidence of SWI at 90 days. The secondary end point was the antibiotic and hospital costs. Results: During the study period, 486 patients underwent isolated coronary artery bypass grafting with a 30-day SWI of 7.6%. 186 high-risk patients were recruited and analysed: 87 in the study group and 99 in the control group. 90-day SWI was significantly reduced in 8 patients in the study group (9.2%; 95% CI 3.5% to 15.3%) compared with 25 patients in the control group (25.2%; 95% CI 19.5% to 39.4%; p = 0.004). The study group had a significantly lower cost of antibiotics (21.2% reduction-US$96/patient; p,0.001), and a significantly lower hospital cost (20.4% reduction in cost-US$3800/patient; p = 0.04). Conclusions: Longer and broader-spectrum antibiotic prophylaxis significantly reduces the incidence of SWI in high-risk patients, with a significant economic benefit in costs of antibiotics as well as hospital costs.

P<0.002), a 68% reduction. Similarly, the incidence of concomitant infection, by the same organism at The incidence of bacterial colonization of central venanother site was reduced from 10 of 35 standard ous catheters using a standard polyurethane catheter catheters to 4 of 44 study catheters (P<0.03), a 63% was compared with that using an antiseptic (silver reduction. sulphadiazine and chlorhexidine) impregnated catheter in a group of patients with thoracic organ trans-Keywords: central venous catheters, infection, transplantation. Colonization was reduced from 25 of 35 plantation standard catheters to 10 of 44 study catheters

The incidence of bacterial colonization of central venous catheters using a standard polyurethane catheter was compared with that using an antiseptic (silver sulphadiazine and chlorhexidine) impregnated catheter in a group of patients with thoracic organ transplantation. Colonization was reduced from 25 of 35 standard catheters to 10 of 44 study catheters (P< 0.002), a 68% reduction. Similarly, the incidence of concomitant infection, by the same organism at another site was reduced from 10 of 35 standard catheters to 4 of 44 study catheters (P < 0.03), a 63% reduction.