Comparative study of cefazolin, cefoxitin, and ceftizoxime for surgical prophylaxis in colo-rectal surgery

Maki, Dennis G.; Aughey, David

doi:10.1093/jac/10.suppl_c.281

“…This rate in our study population was comparable with that reported by others (10,11,14,15). The benefit from redosing had been assumed but had not been proven, and the minimum duration at which redosing is beneficial had been derived from theoretical considerations.…”

Section: Discussionsupporting

confidence: 90%

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Zanetti

¹

,

Giardina

²

,

Platt

³

2001

Emerg. Infect. Dis.

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Intraoperative redosing of prophylactic antibiotics is recommended for prolonged surgical procedures, although its efficacy has not been assessed. We retrospectively compared the risk of surgical site infections in 1,548 patients who underwent cardiac surgery lasting >240 min after preoperative administration of cefazolin prophylaxis. The overall risk of surgical site infection was similar among patients with (43 [9.4%] of 459) and without (101 [9.3%] of 1,089) intraoperative redosing (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.70-1.47). However, redosing was beneficial in procedures lasting >400 min: infection occurred in 14 (7.7%) of 182 patients with redosing and in 32 (16.0%) of 200 patients without (adjusted OR 0.44, 95% CI 0.23-0.86). Intraoperative redosing of cefazolin was associated with a 16% reduction in the overall risk for surgical site infection after cardiac surgery, including procedures lasting <240 min.

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“…The benefit extended beyond this threshold in our study, a finding that may reflect the markedly prolonged serum half-life of cefazolin during cardiopulmonary bypass. Although the half-life of cefazolin is 1.8 h in healthy persons (3), several studies have shown a slower elimination during cardiopulmonary bypass (14,16,17). Therefore, any benefit of redosing in noncardiac surgery may be observed for shorter procedures than in cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Zanetti

¹

,

Giardina

²

,

Platt

³

2001

Emerg. Infect. Dis.

View full text Add to dashboard Cite

Intraoperative redosing of prophylactic antibiotics is recommended for prolonged surgical procedures, although its efficacy has not been assessed. We retrospectively compared the risk of surgical site infections in 1,548 patients who underwent cardiac surgery lasting >240 min after preoperative administration of cefazolin prophylaxis. The overall risk of surgical site infection was similar among patients with (43 [9.4%] of 459) and without (101 [9.3%] of 1,089) intraoperative redosing (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.70-1.47). However, redosing was beneficial in procedures lasting >400 min: infection occurred in 14 (7.7%) of 182 patients with redosing and in 32 (16.0%) of 200 patients without (adjusted OR 0.44, 95% CI 0.23-0.86). Intraoperative redosing of cefazolin was associated with a 16% reduction in the overall risk for surgical site infection after cardiac surgery, including procedures lasting <240 min.

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“…Totally 38 RCTs reported the present or absence of postoperative SSI such as surgical wound infection, abdominal abscess and sub phrenic abscess. Only three (34,36,37) reported systemic infections including sepsis, septicemia and bacteremia while six (35,(38)(39)(40) were distal infections including urinary tract infection and pneumonia. Characteristics of the included trials were shown in table.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three trials (39,44,45), involving 185 participants, compared cefoxitin with first-generation cephalosporins. The controls were cephalothin in one trial (45) and cefazolin in the other two (39, 44).…”

Section: Cefoxitin Vs First-generation Cephalosporinsmentioning

confidence: 99%

Assessing Prophylactic Cephamycins Used in Colorectal Surgery: A Meta-Analysis

Ding¹,

Xu²,

Zhou³

et al. 2015

J Anesth Perioper Med

0

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Background: Cephamycins prophylactic used in colorectal surgery have been widely evaluated, but the uncertainty remains about the comparative effects of different antibiotics. The meta-analysis aimed to assess the efficacy of cephamycins compared with other agents used as prophylaxis in colorectal surgery. Methods: PubMed, EMBASE, and Cochrane Library were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) meeting the criteria was performed using Review Manager. Results: Thirty-nine trials involving 4,755 participants were included in this metaanalysis. The cephamycins were not as effective as other antibiotics for the prevention of postoperative surgical site infection (SSI) (Risk Ratio [RR] 1.18; 95% confidence interval [CI] 1.04, 1.34; P=0.008) and had no advantages in reduction of systemic infection and distal infection. For each antibiotic belonging to cephamycins, there was no statistical difference when cefoxitin and cefotetan were compared with penicillins and cephalosporins on prevention of SSI, while cefmetazole had advantages over cephalosporins on prevention of SSI (RR 0.46; 95% CI 0.22, 0.96; P=0.04). Conclusions:The prophylactic use of cefoxitin and cefotetan in colorectal operations has no significant advantages over other antibiotics. However, cefmetazole may be effective in the prevention of postoperative infections and its efficacy should be researched further and considered by perioperative medical staff. Therefore, it is of great importance to optimize the prophylactic use of antibiotics in colorectal operations.

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Comparative study of cefazolin, cefoxitin, and ceftizoxime for surgical prophylaxis in colo-rectal surgery

Cited by 30 publications

References 0 publications

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery

Assessing Prophylactic Cephamycins Used in Colorectal Surgery: A Meta-Analysis

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