Sources of Contamination in Open Heart Surgery

Kluge, Ronica M.

doi:10.1001/jama.1974.03240100033023

Cited by 116 publications

(9 citation statements)

References 11 publications

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“…Early-onset infections occur within several days or weeks after surgery or catheterization, and in most of these cases, introduction of the etiologic agent(s) takes place during surgery or insertion of the catheter (178). On the other hand, late-onset infections start after a much longer interval of several weeks, months, or years, with the etiologic agent(s) being introduced at the time of surgery, insertion of the catheter, or during bacteremia of another origin (48).…”

Section: Conventional Methodsmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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The clinical significance of coagulase-negative Staphylococcus species (CNS) continues to increase as strategies in medical practice lead to more invasive procedures. Hospitalized patients that are immunocompromised and/or suffering from chronic diseases are the most vulnerable to infection. Since CNS are widespread on the human body and are capable of producing very large populations, distinguishing the etiologic agent(s) from contaminating flora is a serious challenge. For this reason, culture identification should proceed to the species and strain levels. A much stronger case can be made for the identification of a CNS etiologic agent if the same strain is repeatedly isolated from a series of specimens as opposed to the isolation of different strains of one or more species. Strain identity initially can be based on colony morphology, and then one or more molecular approaches can be used to gain information on the genotype. Many of the CNS species are commonly resistant to antibiotics that are being indicated for staphylococcal infections, with the exception of vancomycin. The widespread use of antibiotics in hospitals has provided a reservoir of antibiotic-resistant genes. The main focus on mechanisms of pathogenesis has been with foreign body infections and the role of specific adhesins and slime produced by Staphylococcus epidermidis. Slime can reduce the immune response and opsonophagocytosis, thereby interfering with host defense mechanisms. As we become more aware of the various strategies used by CNS, we will be in a better position to compromise their defense mechanisms and improve treatment.

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Section: Conventional Methodsmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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“…Concentrations of cefazolin in pericardial fluid at 0 to 70, 70 to 139, and 140 to 230 min after a dose tended to be higher than those observed in patients receiving cefonicid, but this difference was not statistically significant (P > 0.05) DISCUSSION It has been suggested that antibiotic prophylaxis should be timed to provide high concentrations of an agent in tissues transversed during surgery. In open-heart surgery, high concentrations of an antimicrobial agent in heart tissue may be particularly useful during the insertion of a prosthetic valve; one study reported 71% of cultures obtained from the exposed area of the heart or prosthetic valve at surgical closure were positive (11). There are some animal and human studies available to support the need of appropriate timing of antimicrobial prophylaxis to obtain optimum serum and tissue concentrations.…”

Section: Resultsmentioning

confidence: 99%

Comparative penetration of cefonicid and cefazolin into the atrial appendage and pericardial fluid of patients undergoing open-heart surgery

Dudley¹,

Nightingale²,

Drezner³

et al. 1984

Antimicrob Agents Chemother

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The penetration of cefonicid and cefazolin into cardiac tissue was compared after a single 30-mg/kg dose in 30 patients undergoing aortocoronary artery bypass graft surgery. Samples of the right atrial appendage, pericardial fluid, and serum were obtained at various times and assayed for drug content. The concentrations of cefonicid in serum and the atrial appendage were at least twice those observed for cefazolin at a given time after a dose. The mean (± standard deviation) atrial appendage-serum ratio was 0.47 ± 0.14 for cefonicid and 0.34 ± 0.06 for cefazolin (P < 0.005). Pericardial Cefonicid is a new cephalosporin with an antimicrobial spectrum similar to that of cefamandole except that it is less active against S. aureus and S. epidermidis. Cefonicid is excreted slowly by the kidneys, with a serum elimination half-life of ca. 4 h. High binding to serum proteins (96 to 98%) results in high concentrations in serum but also reduced the in vitro activity of this agent (6, 7). The high and prolonged concentrations in serum achieved after a single dose may allow for single-dose prophylaxis of infection during certain surgical procedures. In view of the pharmacokinetic properties of cefonicid and the potential usefulness of this agent in surgical prophylaxis, we compared the concentrations of cefonicid and cefazolin in serum, the right atrial appendage, and pericardial fluid of patients undergoing coronary artery bypass graft surgery.( the following were excluded from entry: total body weight (TBW) greater than lean body weight, +/-40%; renal dysfunction (serum creatinine greater than 1.5 mg/dl); history of a significant hypersensitivity reaction to a betalactam antibiotic; requirement for circulatory support (i.e., use of an intro-aortic balloon pump); or inability or refusal to give informed consent. There were two women in the cefonicid group and three women in the cefazolin group. The mean (+ standard deviation) total and ideal weights in the cefonicid group were 70 ± 11 and 66 ± 9 kg, respectively; in the cefazolin group, these weights were 75 ± 10 and 85 ± 10 kg, respectively. The mean preoperative serum creatinine was 1.0 ± 0.2 in the cefonicid group and 1.1 ± 0.2 in the cefazolin group. Each patient underwent a prestudy physical examination, gave a complete medical history, and had the following laboratory tests performed: complete blood count, blood urea nitrogen, serum creatinine, serum bilirubin, serum glutamic-oxaloacetic transaminase, and urinalysis. All of these tests were within the normal range in all patients.Dosing and sample collection. Patients were randomly distributed so as to receive a single 30-mg/kg TBW dose of either cefonicid or cefazolin intravenously over 5 min before surgery. Additional antimicrobial agents were withheld until after the collection of serum and tissue samples. One to three serum samples were collected from each patient during surgery before cardiopulmonary bypass. Blood samples were centrifuged at 3,250 x g for 10 min, and the serum was harvested. Pericardial fluid ...

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“…Kluge et al (11) measured <1 ,ug of CP per ml in plasma during surgery in 69% of patients who were begun on CPB more than 5 h after the last dose of CP. As a possible consequence of low antibiotic levels, contaminating organisms, particularly S. epidermidis and diphtheroids, were recovered from cardiac tissue in 71% of these patients (12). In contrast, during our study, with the administration of CM and CP in the operating room during anesthesia induction, there were no contaminating organisms cultured from pump blood or cardiac tissues during surgery, and serum inhibitory and bactericidal titers at the time of valve insertion were 21:16 in 28 of 30 patients.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Cephalothin and Cefamandole Prophylaxis During Insertion of Prosthetic Heart Valves

Archer

Polk

Duma

et al. 1978

Antimicrob Agents Chemother

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Cefamandole nafate (CM) and cephalothin sodium (CP) were administered as prophylaxis in a randomized, prospective study to 30 consecutive patients undergoing prosthetic cardiac valve insertion. A single dose of 20 mg/kg was given intramuscularly during anesthesia induction, and serial plasma antibiotic concentrations, atrial muscle and cardiac valve tissue antibiotic levels, plasma bactericidal activity against pathogenic staphylococci, and infectious complications were determined and compared for the two drugs. Both antibiotics produced high plasma levels (>20 jig/ml 30 min after injection) which fell less than 25% during the period of cardiopulmonary bypass. However, CM levels were significantly higher at most time periods (P < 0.05) than CP levels. CP levels were undetectable in atrial muscle from 14 of 15 patients and in valves from 10 of 15 patients. In contrast, CM bioactivity was found in all tissues. Differences in tissue antibiotic concentration could not be accounted for by differences in plasma concentrations or by CP tissue binding and were assumed to be caused by differences in penetration. Plasma bactericidal activity against staphylococci was equal for the two drugs (median titer, 1:16). No infections were seen in either group. CM appeared to be an effective and perhaps preferable prophylactic antibiotic for use during cardiac surgery.

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Sources of Contamination in Open Heart Surgery

Cited by 116 publications

References 11 publications

Update on clinical significance of coagulase-negative staphylococci

Update on clinical significance of coagulase-negative staphylococci

Comparative penetration of cefonicid and cefazolin into the atrial appendage and pericardial fluid of patients undergoing open-heart surgery

Comparison of Cephalothin and Cefamandole Prophylaxis During Insertion of Prosthetic Heart Valves

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