АКШ

cardiac surgery

compare the

surgery requiring

presence of

n, mortality,

groups (43

similar in the 2 groups. This

in the setting of

efficacy of

sternotomy were

active

characteristic

cases in the

trial suggests that

a high

vancomycin

considered

infection, the

s of

vancomycin

vancomycin and cefazolin

prevalence of

prophylaxis

eligible for the

use of

microorganis

group, 9.5%, vs.

have similar efficacy in

methicillin-

with that of

trial.

antibiotics

ms isolated

39 cases in the

preventing SSI in cardiac

resistant

cefazolin in

within 2 wk

from the

cefazolin group,

surgery.

staphylococcal

preventing

before the

infection site

9.0%, p=0.8).

infections. 2002

SSI in a

operation,

Superficial and

(245)

tertiary

and a

deep incisional

medical

previous

SSI rates were

center with a

cardiac

also similar in

high

operation

the 2 groups.

prevalence of

requiring

SSI caused by

methicillin-

sternotomy

methicillin-

resistant

within 1 y of

susceptible

staphylococca

enrollment in

staphylococci

l infections.

this trial.

were

significantly

more common

in the

vancomycin

group (17 cases,

3.7%, vs. 6

cases, 1.3%;

p=0.04).

Comparative

To compare 3

RCT

321

Adult patients

Patients with

The

The mean

The prevalence

p=0.05

N/A

Vancomycin deserves

study of

regimens,

undergoing

renal disease

prevalence of

duration of

of surgical

(prevalenc

consideration for inclusion

cefazolin,

using

cardiac or major

or evidence

surgical

postoperative

wound infection

e of

in the prophylactic regimen

cefamandole,

intravenous

vascular

of infection at

wound

hospitalizatio

was lowest with

surgical

(1) for prosthetic valve

and

cefazolin,

operations who

the time of

infection

n, adverse

vancomycin (4

wound

replacement and prosthetic

vancomycin for

cefamandole,

did not have renal

operation and

effects

infections

infections

vascular graft implantation,

surgical

or

disease or

with a known

[3.7%] vs. 14

in

to reduce the risk of implant

prophylaxis in

vancomycin

evidence of

adverse

[12.3%] and 13

vancomyci

infection by methicillin-

cardiac and

for

infection at the

reaction to a

[11.5%] in the

n group

resistant coagulase-negative

vascular

prophylaxis

time of operation

beta-lactam

cefazolin and

vs.

staphylococci and

operations: a

against SSI.

and had not had a

antibiotic or

cefamandole

cefazolin

enterococci; (2) for any

double-blind

known adverse

vancomycin

groups,

and

cardiovascular operation if

randomized

reaction to a beta-

were

respectively;

cefamando

the patient has recently

trial. 1992 (246)

lactam antibiotic

excluded.

p=0.05); there

le)

received broad-spectrum

or vancomycin

were no

antimicrobial therapy; and

were eligible for

thoracic wound

(3) for all CV operations in

participation in

infections in

centers with a high

this study.

cardiac

prevalence of surgical

operations in

infection with methicillin-

the vancomycin

resistant staphylococci or

group (p=0.04).

enterococci.

The mean

duration of

postoperative

hospitalization

was lowest in

the vancomycin

group (10.1 d;

p<0.01) and

highest in the

cefazolin group

(12.9 d). Thus,

administration

of vancomycin

(approximately

15 mg/kg),

immediately

preoperatively,

provides

therapeutic

blood levels for

surgical

prophylaxis

throughout

most cardiac

and vascular

operations,

resulting in

protection

against

postoperative

infection

superior to that

obtained with

cefazolin or

cefamandole.

Comparative

The primary

RCT

3,027

Adult (≥18 y of

Exclusion

SSI rates at

Bacteremia,

Thirty day

p=0.032

N/A

Cefazolin was more

efficacy of

objective of

age) patients

criteria

hospital

respiratory

postoperatively,

(DSWI at

effective prophylaxis than

teicoplanin and

the study was

undergoing

included the

discharge, 30 d

infections,

there was a

6 mo)

teicoplanin against

cefazolin for

to compare

elective CABG,

following:

postoperativel

UTI at

trend to more

postoperative wound

cardiac

the efficacy

valve operations

patients who

y, 6 mo

hospital

deep

infections after elective

operation

of single-dose

(replacement or

were

postoperativel

discharge, 30

sternotomy

cardiac operations.

prophylaxis in

teicoplanin

repair), or both

pregnant and

y

d

wound

3,027 patients.

with

were eligible for

those who

postoperativel

infections in the

2000 (247)

multiple-dose

the trial.

had

y, 6 mo

teicoplanin

cefazolin in

previously

postoperativel

group (31 vs.

the

undergone

y

18, p=0.087),

prophylaxis

sternotomy

which became

of SSI 1 mo

procedures;

significant by 6

after elective

patients with

m (36 vs. 19;

cardiac

severe

p=0.032).

operations.

concomitant

Infection rates

Secondary

diseases, such

were low with

objectives

as the

either treatment.

were to

immunocomp

compare both

romised;

drugs in the

patients who

prevention of

were

SSI at the

morbidly

time of

obese; and

hospital

individuals

discharge and

with

6 mo

osteotomies.

postoperativel

Medically

y; to compare

unstable

both drugs in

patients and

the

those with

prevention of

VAD and/or

nonsurgical

requiring

infections,

IABPs,

noninfectious

transplant, or

complications

total artificial

, and

hearts were

mortality at

not enrolled.

discharge, 1

Patients who

mo, and 6 mo

had received

after the

systemic

operation; to

antibiotics in

compare the

the

microorganis

preoperative

ms

w and those

responsible

allergic to

for infections

glycopeptides

after

, penicillins,

operations;

or

and to

cephalosporin

compare the

s were not

safety of the

eligible.

2 drugs.

Active

bacterial

infections

precluded

entry into the

study, but

asymptomatic

bacteriuria

was allowed.

Patients with

serum

creatinine

levels of 250

µmol/L or

more (2.8

mg/dL) or

neutropenia

of 1,000

cells/mm ≤3

were

excluded. Use

of an

investigationa

l drug or

device in the

30 d before

the operation

was not

allowed nor

was prior

participation

in a trial with

teicoplanin.

Patients of

mental

capacity so

limited as to

preclude

informed

consent were

not enrolled.

Ceftriaxone

This study

RCT

200

All patients

Patients with

Overall rate of

N/A

The overall

NS

N/A

The findings of this study

versus

compared the

undergoing

serum

infections

infection rate

support the adequacy of a

vancomycin

efficacy of

elective heart

creatinine

(wound

was 13.4% in

simple single dose of

prophylaxis in

this narrow-

surgery

levels higher

infections,

the ceftriaxone

ceftriaxone prophylaxis in

CV surgery.

spectrum

than 17 mg/L

mediastinitis,

and 10.7% in

cardiac surgery, at least in

1999 (248)

glycopeptide

were

asymptomatic

the vancomycin

hospitals with low incidence

4 with a

excluded.

bacteriuria,

group. 4 (4%)

of vancomycin-resistant

single dose of

respiratory

wound

staphylococcal infections.

ceftriaxone.

infections)

infections,

including one

mediastinitis,

occurred in the

ceftriaxone

group and 5

(5%) in the

vancomycin

group, with no

statistically

significant

difference.

Comparison of

To

RCT

884

All patients

Patients with

Rate of in-

N/A

The overall

NS

difference between proportions -

The data suggest that

vancomycin

investigate

scheduled for

a known

hospital and

immediate SSI

0.3 (95% CI: -2.6 to 2.1)

vancomycin has no

and cefuroxime

clinically

CABG without

allergy to

late (1 mo) SSI

rate was 3.2%

clinically significant

for infection

significant

valvular surgery

cephalosporin

in the

advantages over

prophylaxis in

differences

os or

cefuroxime

cephalosporin in terms of

coronary artery

between

vancomycin,

group and 3.5%

antimicrobial prophylaxis.

bypass surgery.

vancomycin

an active

in the

We suggest that cefuroxime

1998 (249)

and

infection, or

vancomycin

(or first-generation

cefuroxime

who had

group

cephalosporins, which were

for

received

(difference, -

not studied here) is a good

perioperative

prescribed

0.3; 95% CI: -

choice for infection

infection

antibiotic

2.6 to 2.1).

prophylaxis in connection

prophylaxis

within the

with CABG in institutions

in CABG.

previous 2

without methicillin-resistant

wk, were

Staphylococcus aureus

excluded, as

problems. In addition to the

were patients

increasing vancomycin-

undergoing a

resistant enterococci

repeat bypass

problem, the easier

administration and usually

lower price of cefuroxime

make it preferable to

vancomycin.

Antibiotic

In this present

RCT (2

Trial 1:

All patients

Exclusion

Wound scores

Rates of

Teicoplanin

p<0.01

N/A

In the first trial, teicoplanin

prophylaxis in

study, the

trials in 1

314;

undergoing

criteria of age

bacteremia,

prophylaxis

(400 mg on induction of

cardiac surgery:

development

paper)

Trial 2:

cardiac surgery

under 18 y,

respiratory

resulted in a

anaesthesia and 200 mg 24 h

a prospective

of wound

203

involving CPB

pregnancy,

and urinary

significantly

later), was compared with

comparison of 2

infection

were to be

history of

infections

greater number

tobramycin and

dosage

following

considered for the

allergy to

of sternal

flucloxacillin. Gram-

regimens of

cardiac

trial.

penicillin or

wound

negative bacteria were

teicoplanin with

surgery has

vancomycin,

infections

responsible for more

a combination

been

serum

(p<0.01), due to

respiratory and urinary

of flucloxacillin

examined

creatinine

gram-positive

infections after teicoplanin

and tobramycin.

with a scoring

over

bacteria. In the

prophylaxis.

1998 (250)

method that

150/onol/l,

second trial the

measures the

active

teicoplanin dose

clinical

infection or

regimen was

appearance of

antibiotic

changed to

the wound

treatment

three doses of

and any

within the last

400 mg but this

changes in

7 d, were

did not improve

management

agreed.

the rates of

related to

Midstream

infection.

infection. In

urine

the paper

specimens

there are 2

would be

trials

taken

described,

preoperativel

both

y and patients

compared

with more

different

than 10^5

regimens of

Gramnegative

teicoplanin

bacteria per

vs.

ml of urine

fluclocsacillin

were to be

+tobramycin.

excluded

unless a

repeat

© American College of Cardiology Foundation and American Heart Association, Inc.

specimen was

shown to be

sterile.

Intraoperative

To compare 2

RCT

58

Adult patients

Valvular

The rate and

Hemodynami

In the

p<0.01

Not reported

The results show that a

and

surgical

requiring elective

heart disease

frequency of

c data

vancomycin

significantly greater number

postoperative

population

CABG

requiring

norepinephrine

group, 50% of

of patients who received

effects of

randomized

surgical

infusions

patients

vancomycin required a

vancomycin

to receive

repair or

received a

norepinephrine infusion and

administration

antibiotic

replacement,

norepinephrine

that, despite norepinephrine

in cardiac

prophylaxis

a history of

infusion in the

infusion therapy, systemic

surgery

consisting of

prior open-

intraoperative

vascular resistance was not

patients: a

either

heart surgery,

and/or

normalized in this group of

prospective,

cefazolin or

LVEF of

postoperative

patients. The study supports

double-blind,

both cefasolin

<0.4,

period as

the conclusion that

randomized

and

emergency

compared with

perioperative administration

trial. 1993 (251)

vancomycin.

surgery,

14% in the

of vancomycin in cardiac

In these

chronic renal

normal saline

surgery patients may result

groups

insufficiency

group (p<0.01).

in hypotension requiring the

norepinephrin

(creatinine of

use of a vasopressor in an

use was

>1.8 mg/dL)

attempt to normalize

compared.

or renal

hemodynamic indices.

failure, a

history of

allergic or

adverse

reaction to

cephalosporin

antibiotics or

vancomycin,

chronic

administratio

n of calcium

entry

blockers (due

to effects on

the peripheral

vascular

system),

pregnancy,

prisoners, and

the mentally

impaired.

© American College of Cardiology Foundation and American Heart Association, Inc.

Clinical trial of

To compare 3

RCT

1,641

N/A

N/A

Number of

The depth of

Of the 1,641

NS

N/A

Because no differences in

cefamandole,

cephalosporin

sites of

tissue

participants,

effectiveness in preventing

cefazolin, and

s (cefazolin,

infection

involvement

141 (8.6%) had

postoperative site infections

cefuroxime for

cefamandole,

≥1 operative

were demonstrated in a

antibiotic

cefuroxime)

site infections:

rigorously designed trial, the

prophylaxis in

for antibiotic

46 of 549

costs of the drugs, including

cardiac

prophylaxis

(8.4%)

the costs of their preparation

operations.

in cardiac

cefamandole

and delivery, may be the

1993 (252)

surgery.

recipients, 46 of

only variables by which to

547 (8.4%)

choose among these 3

cefazolin

antibiotic prophylaxis

recipients, and

regimens.

49 of 545

(9.0%)

cefuroxime

recipients

(p=0.92). The

sites of