Antimicrobial prophylaxis in cardiovascular surgery

Abstract

In the past five years three prospective randomized studies compared five different prophylactic antimicrobial regimens in major cardiovascular surgery. In 1980/81 a 4 d cefazolin (CFZ) prophylaxis (16 X 0.5 g) was compared with a 2 d cefuroxime (CFX) administration (4 X 1.5 g). Of the 566 patients who entered the study 281 received CFZ and 285 were given CFX. In 1982/83 a 2 d CFX prophylaxis (4 X 1.5 g) was compared with a two shot ceftriaxone (CRO) prophylaxis (2 g i.v., + 1 g 24 h later). Of the 512 patients enrolled 258 received CFX and 254 CRO. In 1984/85 a 1 d CFZ prophylaxis (4 X 0.5 g) was compared with a single shot prophylaxis of CRO (1 X 2 g). Of the 541 patients who entered the study 272 received CFZ and 269 CRO. All patients of age 16 y or older who were undergoing open heart surgery (n = 1384) and surgery of the major arteries (n = 235) were eligible for trial entry with the following exceptions: patients with preoperative infections, those who had received an antibiotic within 48 h of operation, and any with known allergies to cephalosporins or who had suffered an anaphylactic reaction to any penicillin. The patients were allocated to one of the two treatments by means of a randomized code, stratified for cardiac and major vascular operations. The first dosis was always given prior to surgery at the beginning of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)