Antimicrobial Prophylaxis in Cardiovascular Surgery

Abstract

In the past five years three prospective randomized studies compared five different prophylactic antimicrobial regimens in major cardiovascular surgery. In 1980/81 a 4 d cefazolin (CFZ) prophylaxis (16 X 0.5 g) was compared with a 2 d cefuroxime (CFX) administration (4 X 1.5 g). Of the 566 patients who entered the study 281 received CFZ and 285 were given CFX. In 1982/83 a 2 d CFX prophylaxis (4 X 1.5 g) was compared with a two shot ceftriaxone (CRO) prophylaxis (2 g i.v., + 1 g 24 h later). Of the 512 patients enrolled 258 received CFX and 254 CRO. In 1984/85 a 1 d CFZ prophylaxis (4 X 0.5 g) was compared with a single shot prophylaxis of CRO (1 X 2 g). Of the 541 patients who entered the study 272 received CFZ and 269 CRO. All patients of age 16 y or older who were undergoing open heart surgery (n = 1384) and surgery of the major arteries (n = 235) were eligible for trial entry with the following exceptions: patients with preoperative infections, those who had received an antibiotic within 48 h of operation, and any with known allergies to cephalosporins or who had suffered an anaphylactic reaction to any penicillin. The patients were allocated to one of the two treatments by means of a randomized code, stratified for cardiac and major vascular operations. The first dosis was always given prior to surgery at the beginning of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

The Surgical Infection Prevention Project: Processes, Outcomes, and Future Impact

“…Stone et al [17] randomized post-operative antibiotics versus placebo for patients who had received appropriate pre-operative antibiotics, and found no benefit in elective gastrointestinal and biliary surgery. The data for cardiothoracic surgery [18][19][20][21][22][23][24], total joint replacement [25][26][27][28], peripheral vascular surgery [29,30], colorectal surgery [31][32][33][34][35], and hysterectomy [36][37][38] have consistently demonstrated no value in improving the rates of SSI if antibiotics are continued well into the post-operative period. McDonald et al [39] performed an extensive meta-analysis across all specialties in surgery and demonstrated no difference between single-dose pre-operative antibiotics and pre-operative antibiotics and multiple post-operative doses of the drug.…”

Postoperative Clostridium difficile-associated diarrhea

“…Abdominal surgery is thought to be a risk factor for CDAD,7 and post-surgical CDAD has been well described. The reported rates of post-surgical CDAD range from 0.2% to 8.4% depending on the surgical population studied and types of operations performed 7-13. No study has been reported, however, that compares post-surgical CDAD and medical CDAD with respect to risk factors and outcomes.…”

Ceftriaxone versus Other Cephalosporins for Perioperative Antibiotic Prophylaxis: A Meta-Analysis of 43 Randomized Controlled Trials

“…Surgical wound infections were analyzed in 40 of these studies (n = 13,303 patients), respiratory tract infections in 25 (n = 9,567 patients), and urinary tract infections in 24 (n = 8,865 patients). 17 studies were excluded from further analysis [3,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68].…”