Cardiovascular surgery prophylaxis. A randomized, controlled comparison of cefazolin and cefuroxime.
A prospective double-blind trial was performed at a tertiary care center to evaluate perioperative cephalosporin prophylaxis in cardiac operations. Patients were randomized to receive either cefazolin (n = 104) or cefuroxime (n = 109), the preoperative dose being given within 1 hour before the initial incision. Drugs were continued for 48 hours (cefazolin, 1 gm intravenously every 8 hours; cefuroxime, 1.5 gm intravenously every 12 hours). Postoperative infections were assessed by trained nurse clinicians, and data were analyzed by the intention-to-treat principle. Sternal wound infections or mediastinitis occurred in one of 104 patients treated with cefazolin and 10 of 109 treated with cefuroxime (p = 0.01). Deep sternal wounds (including mediastinitis and sternal osteomyelitis) occurred in none of the cefazolin-treated patients and five cefuroxime-treated patients (p = 0.06). Although overall nosocomial infection rates were similar (16.3 versus 19.3 per 100), wound infection occurred somewhat more frequently with streptococci (groups B and D) in patients receiving cefazolin (four versus zero, p = 0.110); conversely staphylococcal infections were more frequent in the cefuroxime group (seven versus one, p = 0.066). Mean and median postoperative stay was 1 day shorter in the cefazolin group. In contrast to findings of a previous report, our data indicate that cefazolin prevented more sternal wound infections than cefuroxime, a finding that supports prophylaxis with a first-generation cephalosporin.
Department of Medicine, University of Iowa College of Medicine, Iowa City.
B N
BN
Doebbeling
M A
MA
Pfaller
K R
KR
Kuhns
R M
RM
Massanari
D M
DM
Behrendt
R P
RP
Wenzel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002437:Cefazolin / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000191:economics; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology
D002511:Cephalosporins; D002437:Cefazolin; D002444:Cefuroxime