Antibiotic prophylaxis in non-cardiac thoracic surgery: Cefazolin versus placebo

Abstract

A total of 127 patients (57 given placebo and 70 given a single preoperative dose of 1 g cefazolin) undergoing thoracic surgery were included in a randomized double-blind trial. The two groups were similar in regard to mean age, sex ratio, in-hospital stay before surgery, underlying disease, risk factors, type of surgery, mean duration of surgical procedure, and mean duration of chest tube drainage. The relative risk of wound infection of the patients from the placebo group was 3.27 (range 1.5-11.5; 95% confidence interval). Cefazolin significantly reduced (p less than 0.01) the wound infection rate--1 case (1.5%) in the cefazolin group versus 8 cases (14%) in the placebo group--but not the incidence of postoperative pleural empyema--5 (7%) versus 8 cases (14%)--or nosocomial pneumonia--3 (4%) versus 5 cases (9%). Cultures were made from 3 out of 9 wound infections and Staphylococcus aureus or S. epidermidis was isolated in all 3. In addition, cultures were made from 6 out of 13 pleural cavity infections and S. aureus (1 case) or other microorganisms (5 cases) were isolated in all 6. Mortality was similar in both groups and all deaths unrelated to the infections. No adverse side effects of the drug were encountered. In conclusion, a single preoperative dose of 1 g cefazolin proved to be effective for reducing the wound infection rate in non-cardiac thoracic surgery.

A Randomized Trial of Antimicrobial Prophylaxis in Patients Undergoing Medical Thoracoscopy (APT)

“…The overall incidence of surgical site infections (4%) and empyema (6%) in the entire study population of the current study was lower than that reported in the study by Aznar et al [5] . This is because medical thoracoscopy is generally a much shorter and less extensive procedure than thoracic surgery.…”

“…Surgical site infection occurred in 1 subject (2%) in the antibiotic group and 3 subjects (6%) in the saline group ( p = 0.62); empyema occurred in 3 subjects (6%) in each group ( p = 1.00). There was no association between age, comorbid illness (diabetes mellitus or chronic kidney was found to be effective in reducing the wound infection rate in noncardiac thoracic surgery [5] . In another study, a single dose of 1.5 g of cefuroxime given preoperatively did not reduce the incidence of postoperative infection in patients undergoing thoracic surgery as compared to no antibiotic use [7] .…”

“…In the current study, we used a protocol of a single preprocedural dose of cefazolin (though with a higher dose of 2 g) similar to that of Aznar et al [5] , but did not find a difference in the incidence of wound or pleural space infection. The overall incidence of surgical site infections (4%) and empyema (6%) in the entire study population of the current study was lower than that reported in the study by Aznar et al [5] .…”

“…In yet another study in 200 patients undergoing major thoracic surgery, a single dose of cefuroxime 1.5 g did not reduce infections of the wound, pleural space, and urinary tract significantly compared with placebo [7] . In a study by Aznar et al [5] , a single preoperative dose of 1 g of cefazolin was compared to placebo in patients undergoing thoracic surgery. Cefazolin reduced the incidence of wound infection significantly (1.5% in the antibiotic group vs. 14% in the placebo group) but not the incidence of empyema (7 vs. 14% in the antibiotic and placebo group, respectively).…”

“…Several studies have tested the effectiveness of antimicrobial drugs for the prevention of postoperative infections after noncardiac thoracic surgery [5][6][7] . In a previous study, a single preoperative dose of 1 g of cefazolin…”