RANDOMIZED, PROSPECTIVE COMPARISON OF FIRST-GENERATION AND 2ND-GENERATION CEPHALOSPORINS AS INFECTION PROPHYLAXIS FOR CARDIAC-SURGERY

被引:19
作者
CURTIS, JJ [1 ]
BOLEY, TM [1 ]
WALLS, JT [1 ]
HAMORY, B [1 ]
SCHMALTZ, RA [1 ]
机构
[1] UNIV MISSOURI,DIV INFECT DIS,COLUMBIA,MO 65212
关键词
D O I
10.1016/S0002-9610(05)80689-0
中图分类号
R61 [外科手术学];
学科分类号
摘要
Surgical wound infections after cardiovascular surgery may be life threatening and are resource intensive. Second-generation cephalosporins are purported to have a broader antimicrobial spectrum than first-generation cephalosporins and, therefore, may be more efficacious for infection prophylaxis. We have conducted a randomized prospective study of 702 patients undergoing open heart surgery to test the hypothesis that the second-generation cephalosporin, cefuroxime, will be more efficacious for infection prophylaxis than the first-generation cephalosporin, cefazolin. Patients were randomized to receive cefazolin 1 g intravenously every 8 hours for 48 hours begun 1 hour preoperatively plus 1 g after 4 hours of surgery (8 doses, n = 425) or cefuroxime 1.5 g 1 hour prior to surgery plus 1.5 g every 12 hours for 3 additional doses (4 doses, n 277). Infection was defined as a draining wound with or without a positive culture. There was no difference in the wound infection rate between the groups (p = 0.68). Chest wound infections occurred in 2.1% of patients treated with cefazolin and 2.9% of patients treated with cefuroxime (p = 0.79). The rate of true mediastinitis requiring exploration and drainage was 0.7% in both groups (p = 0.84). Leg infections occurred in 6.6% of cefazolin-treated patients and 5.6% of cefuroxime-treated patients (p = 0.83). The second-generation cephalosporin, cefuroxime, did not reduce the incidence of wound infection when compared with the first-generation cephalosporin, cefazolin. Since institutional antibiotic acquisition and administration costs vary, careful analysis of these factors will allow determination of the most cost-effective infection prophylaxis regimen in cardiac surgery.
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页码:734 / 737
页数:4
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