Intraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: A randomized, double-blind study

Romanelli, V A; Howie, Michael B.; Myerowitz, P. David; Rezaei, A.; Jackman, D.L.; Sinclair, Daniel S.; Fuhrman, Thomas M.; McSweeney, Thomas D.

doi:10.1016/1053-0770(92)90420-c

Cited by 9 publications

(13 citation statements)

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“…In another trial, vancomycin was administered as postprocedure prophylaxis, and thus the trial did not fit the criterion that a study involve preoperative prophylaxis [26]. In the last trial that was eliminated, postoperative infection rates were not determined [27]. Thus, a total of 6 articles that reported the results of 7 randomized, controlled trials met our inclusion criteria and were included in the analysis [28][29][30][31][32][33].…”

Section: Resultsmentioning

confidence: 99%

Glycopeptides Are No More Effective than -Lactam Agents for Prevention of Surgical Site Infection after Cardiac Surgery: A Meta-analysis

Bolon

Morlote

Weber

et al. 2004

Clinical Infectious Diseases

134

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A meta-analysis was performed to investigate whether a switch from beta-lactams to glycopeptides for cardiac surgery prophylaxis should be advised. Results of 7 randomized trials (5761 procedures) that compared surgical site infections (SSIs) in subjects receiving glycopeptide prophylaxis with SSIs in those who received beta -lactam prophylaxis were pooled. Neither agent proved to be superior for prevention of the primary outcome, occurrence of SSI at 30 days (risk ratio [RR], 1.14; 95% confidence interval [CI], 0.91-1.42). In subanalyses, beta-lactams were superior to glycopeptides for prevention of chest SSIs (RR, 1.47; 95% CI, 1.11-1.95) and approached superiority for prevention of deep-chest SSIs (RR, 1.33; 95% CI, 0.91-1.94) and SSIs caused by gram-positive bacteria (RR, 1.36; 95% CI, 0.98-1.91). Glycopeptides approached superiority to beta-lactams for prevention of leg SSIs (RR, 0.77; 95% CI, 0.58-1.01) and were superior for prevention of SSIs caused by methicillin-resistant gram-positive bacteria (RR, 0.54; 95% CI, 0.33-0.90). Standard prophylaxis for cardiac surgery should continue to be beta-lactams in most circumstances.

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Section: Resultsmentioning

confidence: 99%

Glycopeptides Are No More Effective than -Lactam Agents for Prevention of Surgical Site Infection after Cardiac Surgery: A Meta-analysis

Bolon

Morlote

Weber

et al. 2004

Clinical Infectious Diseases

134

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“…One group observed 25% of 116 consecutive patients developed hypotension, which in one-half of the cases was severe (19). A second group determined that while initial doses of vancomycin were well-tolerated, subsequent doses caused hypotension that often required norepinephrine infusion after bypass (20). A third group concluded that the adverse reactions to vancomycin could be minimized by starting the infusion after initiating bypass (21).…”

Section: Overview Of Vancomycin Pharmacologymentioning

confidence: 99%

Prophylactic Use of Vancomycin in Adult Cardiology and Cardiac Surgery

Movahed

Kasravi

Bryan

2004

J Cardiovasc Pharmacol Ther

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The recent appearance of S. aureus and S. epidermidis strains with reduced susceptibility to vancomycin and the spread of vancomycin-resistant enterococci raise the specter of endovascular infections that will be difficult or impossible to cure with available drugs. We review issues concerning prophylactic use of vancomycin in adult cardiology and cardiac surgery with special attention to dosing and indications. There is no indication for routine use of prophylactic vancomycin in pacemaker implantations, cardiac catheterization, and transesophageal echocardiography. In institutions with high incidence of MRSA and MRSE, vancomycin may be used for antibiotic prophylaxis in place of cephalosporins for pacemaker or defibrillator implantation. Strongest evidence in support of prophylactic use of vancomycin is during cardiac surgeries particularly valvular surgeries in institutions with high prevelance of MRSA and MRSE. When vancomycin is used prior to open heart surgery, the dose should be 15 mg/kg rather than a standard 1 g dose often recommended in the literature and used by 85% of institutional pharmacists who responded to our survey. Cardiologists and cardiac surgeons should assume leadership roles in promoting its responsible use. Condensed abstractThe emergence of vancomycin-resistant bacteria should concern cardiologists and cardiac surgeons because of the potential for untreatable endovascular infections. We review current guidelines and controversies concerning the appropriate use of this agent.

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“…15 Romanelli and colleagues randomised patients undergoing CABG to vancomycin or placebo (in addition to cefazolin) to assess the haemodynamic effects of vancomycin administration. 31 All AE data are summarised in Table 9.…”

Section: Figure 11mentioning

confidence: 99%

“…15,30,31 One study compared vancomycin with cefamandole (both with or without aprotinin), 30 although its aim was to assess the effect of these drugs on kidney function. Miro and colleagues reported adverse events from an open, non-randomised study comparing patients undergoing CABG or valve replacement from 1992 to 1994 who received teicoplanin prophylaxis with patients from 1990 to 1992 who received vancomycin.…”

Section: Figure 11mentioning

confidence: 99%

“…21 Hypotension requiring a norepinephrine infusion occurred in 5% (37/736) of vancomycin plus cefazolin patients compared with 14.3% (4/28) of cefazolin patients in a third study, although the aim of this study was to assess the haemodynamic effects of drug infusion, not its prophylactic effectiveness. 31 One teicoplanin study also reported hypotension, which occurred in three teicoplanin patients (0.2%) compared with five (0.3%) cefazolin patients. Other AEs reported were generally mild and included nausea, vomiting and rash.…”

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confidence: 99%

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A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

2008

Clinical Governance: An International Journal

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Intraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: A randomized, double-blind study

Cited by 9 publications

References 0 publications

Glycopeptides Are No More Effective than -Lactam Agents for Prevention of Surgical Site Infection after Cardiac Surgery: A Meta-analysis

Glycopeptides Are No More Effective than -Lactam Agents for Prevention of Surgical Site Infection after Cardiac Surgery: A Meta-analysis

Prophylactic Use of Vancomycin in Adult Cardiology and Cardiac Surgery

A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

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