Prospective randomised comparison of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery bypass grafting

Abstract

To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting, 1,016 consecutive patients were prospectively randomized to receive either a single dose or a three-day course of cefuroxime. Nine patients (0.9%) died within seven days; no death was caused by infection. For various reasons 163 other patients were not evaluable. Therefore, 844 patients were evaluated. Patients in group A (n = 419) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia; group B (n = 425) received the same dose followed by 750 mg t.i.d. for three consecutive days. Both groups were comparable regarding all risk factors. The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups. No significant differences in wound infection were observed between the two treatment groups: sternal site infection in the single-dose prophylaxis group was 14% versus 13% in the three-day course group; donor site infection occurred in 38% versus 39%. It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection.

The Surgical Infection Prevention Project: Processes, Outcomes, and Future Impact

“…Stone et al [17] randomized post-operative antibiotics versus placebo for patients who had received appropriate pre-operative antibiotics, and found no benefit in elective gastrointestinal and biliary surgery. The data for cardiothoracic surgery [18][19][20][21][22][23][24], total joint replacement [25][26][27][28], peripheral vascular surgery [29,30], colorectal surgery [31][32][33][34][35], and hysterectomy [36][37][38] have consistently demonstrated no value in improving the rates of SSI if antibiotics are continued well into the post-operative period. McDonald et al [39] performed an extensive meta-analysis across all specialties in surgery and demonstrated no difference between single-dose pre-operative antibiotics and pre-operative antibiotics and multiple post-operative doses of the drug.…”

Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance

“…[2][3][4] Among the different approaches to prevent these infections, antimicrobial prophylaxis is of substantial importance. Despite evidence from randomized clinical trials and other data supporting antibiotic prophylaxis (ABP) for no longer than 48 hours, [5][6][7][8] controversy persists about the optimal duration of prophylaxis. 9,10 In particular, it is still common practice to continue ABP for Ͼ48 hours after cardiac surgery until all chest tubes are removed.…”

Surgical Site Infections in Relation to the Timing of Shaving among the Gastrointestinal Emergency Patients through the Midline Incisions- A Randomized Controlled Clinical Trial

“…Other studies corroborate that increased length of hospital stay and cost are associated with SSIs [21][22][23]. Deep SSIs involving organs or spaces, as compared to SSIs confined to the incision, are associated with even greater increases in hospital stays and costs [24][25][26].…”