Comparative study of cefazolin, cefamandole, and vancomycin for surgical prophylaxis in cardiac and vascular operations

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

“…This retrospective study demonstrates that intraoperative redosing of cefazolin provided additional protection against surgical site infection among patients undergoing cardiac surgery lasting longer than approximately 6.5 to 7 h. Although this group includes only a minority of procedures, we estimate from our data that a strategy of redosing in all procedures >240 min long results in a 16% reduction in the overall infection rate in cardiac surgery. This rate in our study population was comparable with that reported by others (10,11,14,15). The benefit from redosing had been assumed but had not been proven, and the minimum duration at which redosing is beneficial had been derived from theoretical con-siderations.…”

“…The benefit extended beyond this threshold in our study, a finding that may reflect the markedly prolonged serum half-life of cefazolin during cardiopulmonary bypass. Although the half-life of cefazolin is 1.8 h in healthy persons (3), several studies have shown a slower elimination during cardiopulmonary bypass (14,16,17). Therefore, any benefit of redosing in noncardiac surgery may be observed for shorter procedures than in cardiac surgery.…”

Perioperative management of neurosurgical patients with methicillin-resistant Staphylococcus aureus

“…Cardiac and vascular surgeons have particularly struggled with MRSA wound infections, perhaps because their patients tend to have lengthy skin incisions, poor vascular supply, and a high prevalence of diabetes. The authors of a randomized trial 21 comparing prophylaxis with 3 antibiotic regimens before cardiac and major vascular operations demonstrated postoperative wound complication rates of 3.7% with vancomycin, 12.3% with cefazolin, and 11.5% with cefamandole. Hypotension occurred in 8 of 107 patients who received vancomycin and improved with diphenhydramine and a slower rate of infusion.…”

Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for sternal wound infection in high-risk patients following coronary artery bypass grafting surgery: a prospective randomised double-blind controlled trial

“…2 5 21 Despite this, four studies have chosen to compare cephalosporins with vancomycin alone. Maki et al 23 showed a benefit of vancomycin (15 mg/kg). By contrast, Finkelstein et al 24 compared vancomycin 1 g three times daily for 24 h with cefazolin 1 g three times daily for 24 h, 24 14 despite showing an overall reduction in infection, had seen an increase in Gram-negative infections after the use of narrow-spectrum prophylaxis.…”