Prophylactic Vancomycin versus Placebo in Arterial Prosthetic Reconstructions

Abstract

Vascular reconstructive surgery with the placement of prosthetic material caudal to the diaphragm is occasionally associated with postoperative wound infection. These infections often lead to amputation and can be lethal. Only a few published reports contain information on the value of prophylactic antibiotic treatment with these operations, but its use is common throughout the world. To investigate this problem, a prospective, double blind, randomized study of vancomycin versus placebo in 128 vascular graft operations caudal to the diaphragm was conducted from June, 1982 to July, 1984. The difference in infection rate was significant (2 p = 0.0008) in favor of the vancomycin group. Fourteen wound infections (21.2%) were found in the placebo group, 3 of which (4.5%) were prosthesis infections. Among the 62 vancomycin-treated patients, one case of superficial wound infection (1.6%) and no cases of prosthesis infection were found. The most common pathogen was Staphylococcus aureus. The study has demonstrated that vancomycin, a narrow spectrum antibiotic, in an ultra-short regimen (one gram one hour before surgery and one gram 4 hours later) is an effective prophylactic agent against postoperative wound infection. Temporary and, in most cases, doses-related side effects were seen in 7.9% of the patients treated with vancomycin.

Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection

“…While most surgeons use cephalosporins, the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci as surgical wound pathogens in many institutions (34, 38) has prompted a search for alternative prophylactic regimens. Although vancomycin use in neurologic, cardiothoracic, and vascular surgery (5,16,18,19,29,41,44) …”

“…While most surgeons use cephalosporins, the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci as surgical wound pathogens in many institutions (34,38) has prompted a search for alternative prophylactic regimens. Although vancomycin use in neurologic, cardiothoracic, and vascular surgery (5,16,18,19,29,41,44) has been evaluated, its tendency to cause hypotension (33,35) has been problematic in surgical trials. This side effect may be especially dangerous for patients already rendered hypotensive by surgical anesthesia, their underlying disease, or the need for cardiopulmonary bypass.…”

Antibacterial prophylaxis in surgery: 3 - Arterial surgery in the abdomen, pelvis and lower limbs

“…Randomised double-blind placebo-controlled trials, conducted over 20 years ago (and so predating the rise of MRSA), demonstrated that antibacterial prophylaxis, administered intravenously around 1 hour pre-operatively and continued for up to 24 hours after the operation, reduced the incidence of wound infection following reconstructive arterial surgery, typically by around two-thirds 20–24. The incidence of wound infection was around 7-25% with placebo, compared with around 1-6% in patients given prophylaxis (e.g.…”

Antibiotic Prophylaxis in Autologous Vein Graft Reconstructions of the Lower Extremity

“…3 All the studies analyzed in this review included both prosthetic surgery and vein graft surgery. [4][5][6][7][8][9][10][11][12][13] Surgical site infection (SSI) after arterial reconstructive surgery of the lower extremity is assumed to be a multifactorial entity. [14][15][16] Different factors appear to influence the incidence of SSI.…”