Prospective, Randomized, Double-Blind Trial Comparing Teicoplanin and Cefazolin as Antibiotic Prophylaxis in Prosthetic Vascular Surgery

Abstract

To compare efficacy, tolerability, and cost of antibiotic prophylaxis with teicoplanin and cefazolin in clean prosthetic vascular surgery, a randomized, prospective, double-blind study was performed at the Vascular Surgery Unit of a tertiary-care university hospital. Two-hundred thirty-eight consecutive patients undergoing elective, clean, abdominal or lower-limb prosthetic vascular surgery were allocated to receive a single intravenous dose of teicoplanin (400 mg) or cefazolin (2 g) at the induction of anesthesia. Surgical-site infections occurred in 5.9% of teicoplanin recipients (4.2% wound infection, 1.7% graft infection) and 1.7% of cefazolin recipients (1.7% wound infection, 0% graft infection) (P=0.195). Other postoperative infections occurred in 10% of teicoplanin recipients (pneumonia 7%, urinary tract infection 3%) and 12% of cefazolin recipients (pneumonia 7%, urinary tract infection 2.5%, bloodstream infections 2.5%). Overall mortality rate was 3.4% in teicoplanin recipients (4 patients) and 2.5% in cefazolin recipients (3 patients). Infective deaths occurred in one patient for each group. The two prophylactic regimens were well tolerated. Cost savings of US $52,510 favoring cefazolin were related to the lower acquisition cost (US $1034 vs US $4740) and to the shorter duration of the hospital stay (1762 days vs 1928 days). Cefazolin can still be regarded as the drug of choice for prophylaxis in clean vascular surgery.

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

“…[296][297][298] There are insufficient published data to recommend vancomycin for perioperative prophylaxis. It is unlikely that placebo-controlled, blinded studies will be published for primary prophylaxis in patients who undergo endovascular device placement; however, the administration of a perioperative β-lactam antibiotic may be considered.…”

“…In the post-antibiotic drug era, antimicrobial prophylaxis for dental procedures has been suggested for >25 medical conditions (eg, valvular heart disease or in patients who have implanted devices, such as a joint arthroplasty). [297][298][299][300][301] The efficacy of secondary prophylaxis for dental procedures is unproven and is based largely on the potentially devastating consequences of infections in these patients rather than on scientific evidence. [302][303][304] The rationale for secondary prophylaxis for patients who undergo a dental procedure to prevent a vascular graft or endovascular device infection is based largely on case reports, textbook chapters, or expert opinion.…”

In vitro evaluation of the antimicrobial efficacy of a new silver-triclosan vs a silver collagen-coated polyester vascular graft against methicillin-resistant Staphylococcus aureus

“…Although many are outdated, a number of studies have investigated the utility of systemic prophylactic antibiotics in vascular surgery, and a variety of systemically administrated antibiotics, singly or in combination, have been proposed. [17][18][19][20] Only a few studies have investigated antimicrobial graft materials, predominantly containing topical antibiotics and some using topical antiseptics. In recent decades, various concepts for antimicrobial grafts have been developed to prevent vascular graft infection.…”

Pharmacokinetic–pharmacodynamic aspects of antimicrobial prophylaxis with teicoplanin in patients undergoing major vascular surgery

“…Glycopeptides should be used wisely with the intent of avoiding the spread of resistance [11], although the prophylactic role of teicoplanin in cardiovascular surgery has been supported by some authors [12,13]. Additionally, although not always proven to be more effective than ␤-lactams for prevention of SSIs [14][15][16], glycopeptides were postulated to be particularly advantageous during cardiovascular procedures involving implants, considering the possible negative impact of SSIs occurring in this context [17].…”

“…Although ultrashort or short regimens should be preferred in cardiovascular surgery [15,21], some authors still continue supporting the opportunity for longer regimens [22,23].…”