title: Randomized, prospective comparison of first- and second-generation cephalosporins as infection prophylaxis for cardiac surgery.
abstract: 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 = 0.084). 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.
authors.affiliation: Division of Cardiothoracic Surgery, University of Missouri-Columbia 65212.
authors.forename: J J
authors.initials: JJ
authors.lastname: Curtis
authors.forename: T M
authors.initials: TM
authors.lastname: Boley
authors.forename: J T
authors.initials: JT
authors.lastname: Walls
authors.forename: B
authors.initials: B
authors.lastname: Hamory
authors.forename: R A
authors.initials: RA
authors.lastname: Schmaltz
mesh_terms: D006348:Cardiac Surgical Procedures; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use*; D002444:Cefuroxime / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D002437:Cefazolin; D002444:Cefuroxime