Cardiovascular surgery prophylaxis. A randomized, controlled comparison of cefazolin and cefuroxime

B. N. Doebbeling, M. A. Pfaller, K. R. Kuhns, R. M. Massanari, D. M. Behrendt, R. P. Wenzel

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)981-989
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume99
Issue number6
StatePublished - Jul 11 1990
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Doebbeling, B. N., Pfaller, M. A., Kuhns, K. R., Massanari, R. M., Behrendt, D. M., & Wenzel, R. P. (1990). Cardiovascular surgery prophylaxis. A randomized, controlled comparison of cefazolin and cefuroxime. Journal of Thoracic and Cardiovascular Surgery, 99(6), 981-989.