Efficacy of Cefazolin, Cefamandole, and Gentamicin as Prophylactic Agents in Cardiac Surgery

Abstract

In an effort to develop an improved regimen of antibiotic prophylaxis in cardiac surgery, 1030 patients who were to have elective cardiothoracic surgery involving a median sternotomy were selected at random to receive cefamandole or cefazolin, with or without gentamicin, in a prospective double-blind study. Cefazolin was significantly less effective than cefamandole at both the sternal (1.8% vs. 0.4%, respectively, p less than 0.05) and donor sites (1.3% vs. 0%, respectively, p less than 0.02). Seven Staphylococcus aureus infections occurred among cefazolin recipients as compared with no such infections among the patients receiving cefamandole (p less than 0.01). All five wound infections yielding fungi or gentamicin-resistant gram-negative rods occurred in patients who had received gentamicin as a second prophylactic agent. These data suggest that gentamicin has no role as a prophylactic antibiotic in cardiac surgery and that, compared with cefamandole, cefazolin offers unreliable prophylaxis against deep infection at both the sternal and donor sites.

Reappraisal of the antistaphylococcal activities of first-generation (narrow-spectrum) and second-generation (expanded-spectrum) cephalosporins

“…There were no differences in the rates of postoperative wound infections. In the two larger studies, both cefamandole and cefuroxime clearly reduced the incidence of wound infections in comparison with cefazolin (14,28).…”

“…In contrast, Gentry and colleagues (9) found no differences (14,28) in which wound infection pathogens were available, the microbiology of these postoperative infections indicated that, despite prophylaxis, staphylococci continued to produce infectious complications (Table 2). S. aureus and S. epidermidis accounted for more than one-half of the wound infections among cefazolin recipients.…”

“…Cefazolin has been considered ideal for this purpose because of its pharmacokinetic properties and broad-spectrum antimicrobial activity. Well-designed, placebo-controlled trials have demonstrated that cefazolin reduces the incidence of postoperative wound infections in comparison with placebos in patients undergoing vascular surgery (13) and total hip replacement (11 (14,19,28). The smaller study by Meszaros and colleagues (19) can be criticized because significant differences between treatment groups were apparent only when all infections were included.…”

Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty

“…24 There is also no doubt that antibiotic prophylaxis is needed in selected "clean" surgical procedures where a prosthesis is implanted, because the consequences of a graft infection can be severe or even fatal. 25,26 Hip or knee arthroplasties 25 and cardiac or vascular graft implants 26 are "clean" procedures in which perioperative antibiotic coverage has been shown to be beneficial and is clearly indicated. However, the benefit of antibiotic prophylaxis in other "clean" surgical procedures, such as tension-free hernioplasty, has been considered questionable.…”

beta-Lactamase-mediated inactivation and efficacy of cefazolin and cefmetazole in Staphylococcus aureus abscesses

“…A small number of clinical trials also suggest that P-lactamase activity may be clinically important. Although conflicting data have been reported (6), some studies of cephalosporins used as prophylaxis in cardiac surgery have indicated that either cefamandole (13,22) or cefuroxime (22) is more effective than cefazolin in prophylaxis of S. aureus wound infections. In addition, Kernodle et al (14) demonstrated that staphylococcal type A ,B-lactamase production is associated with a greater number of clean wound infections with cefazolin prophylaxis than with cefamandole prophylaxis.…”