Comparison of vancomycin and cefuroxime for infection prophylaxis in coronary artery bypass surgery

Abstract

Objective: To investigate clinically significant differences between vancomycin and cefuroxime for perioperative infection prophylaxis in coronary artery bypass surgery.

Design: A total of 884 patients were randomized prospectively to receive either cefuroxime (444) or vancomycin (440) and were assessed for infectious complications during hospitalization and 1 month postoperatively.

Setting: A university hospital.

Results: The overall immediate surgical-site infection rate was 3.2% in the cefuroxime group and 3.5% in the vancomycin group (difference, -0.3; 95% confidence interval, -2.6-2.1).

Conclusions: The data suggest that vancomycin has no clinically significant advantages over cephalosporin in terms of antimicrobial prophylaxis. We suggest that cefuroxime (or first-generation cephalosporins, which were not studied here) is a good choice for infection prophylaxis in connection with coronary artery bypass surgery in institutions without methicillin-resistant Staphylococcus aureus problems. In addition to the increasing vancomycin-resistant enterococci problem, the easier administration and usually lower price of cefuroxime make it preferable to vancomycin.