cefamandole and Cross-Infection

Three-hundred twenty-one adults undergoing cardiac or major vascular operations were randomized to receive intravenous cefazolin, cefamandole, or vancomycin for prophylaxis against surgical infection in a double-blind trial. All three regimens provided therapeutic blood levels throughout operation in patients studied undergoing cardiopulmonary bypass. The prevalence of surgical wound infection was lowest with vancomycin (4 infections [3.7%] versus 14 [12.3%] and 13 [11.5%] in the cefazolin and cefamandole groups, respectively; p = 0.05); there were no thoracic wound infections in cardiac operations in the vancomycin group (p = 0.04). The mean duration of postoperative hospitalization was lowest in the vancomycin group (10.1 days; p < 0.01) and highest in the cefazolin group (12.9 days). Prophylaxis with vancomycin or cefamandole, compared with cefazolin, did not prevent nosocomial cutaneous colonization by methicillin-resistant coagulase-negative staphylococci; colonization or infection with vancomycin-resistant staphylococci or enterococci was not detected. Adverse effects attributable to the prophylactic regimen were infrequent in all three groups. Eight patients given vancomycin became hypotensive during administration of a dose, despite infusion during a 1-hour period; however, slowing the rate of administration and pretreating with diphenhydramine allowed vancomycin to be resumed and prophylaxis completed uneventfully in five of the patients. We conclude that administration of vancomycin (approximately 15 mg/kg), immediately preoperatively, provides therapeutic blood levels for surgical prophylaxis throughout most cardiac and vascular operations, resulting in protection against postoperative infection superior to that obtained with cefazolin or cefamandole. Vancomycin deserves consideration for inclusion in the prophylactic regimen (1) for prosthetic valve replacement and prosthetic vascular graft implantation, to reduce the risk of implant infection by methicillin-resistant coagulase-negative staphylococci and enterococci; (2) for any cardiovascular operation if the patient has recently received broad-spectrum antimicrobial therapy; and (3) for all cardiovascular operations in centers with a high prevalence of surgical infection with methicillin-resistant staphylococci or enterococci. Guidelines for dosing and administration of vancomycin for cardiovascular surgical prophylaxis are provided.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Cross Infection; Double-Blind Method; Female; Humans; Male; Methicillin Resistance; Middle Aged; Staphylococcus; Surgical Wound Infection; Treatment Outcome; Vancomycin; Vascular Surgical Procedures

We undertook a prospective randomized evaluation of cefamandole nafate, cefuroxime sodium, and cefazolin sodium as prophylaxis in open-heart operations. A total of 903 patients having an elective procedure were enrolled in the study, and 620 of them were eventually considered evaluable. There were no significant differences between the three study groups. The overall rate of infection and the rate of infection according to demographic variables was not significantly different between the three antibiotics. Serious complications and deaths were also similar between the three agents. The presence of multiple severe underlying conditions was a risk factor for infection, independent of the antibiotic used. We conclude that there are no differences in the efficacies of the three agents in preventing postoperative infections in patients having open-heart operation. Cefuroxime, principally because of its every-12-hour dose, is far less expensive than cefamandole or cefazolin.

Topics: Cardiac Surgical Procedures; Cefamandole; Cefazolin; Cefuroxime; Cephalosporins; Cross Infection; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Risk Factors; Surgical Wound Infection

The possible advantages of the monobactam antibiotic aztreonam in the treatment of hospital-acquired urinary tract infection were assessed in a study comparing aztreonam (0.5 to 1 g twice daily or three times daily) to cefamandole (1 g three times daily) in 159 patients. Initial pathogens were eradicated in 91.7 percent of the patients of the aztreonam group who were treated three times daily, in 82.7 percent of the group treated twice daily, and in 78.3 percent of the patients receiving cefamandole. Reinfection and superinfection were most commonly caused by enterococci in the aztreonam groups and by Pseudomonas aeruginosa in the cefamandole group. In a second study, 35 patients infected with organisms resistant to other antibiotics were treated with aztreonam 1 to 6 g per day for eight days. The overall cure rates were 93 percent for Pseudomonas infections, 87.5 percent for Escherichia coli infections, and 100 percent for other pathogens.

Topics: Anti-Bacterial Agents; Aztreonam; Cefamandole; Cross Infection; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Random Allocation; Recurrence; Urinary Tract Infections; Urine

More than 12,800 clinical isolates from 115,373 in-patient specimens obtained at the Sir Charles Gairdner Hospital, Perth, Western Australia, were identified and analysed statistically for relationships with usage of three generations of cephalosporins over the 5-year period from July 1984 to June 1989. A positive relationship between cephalosporin usage and significantly increasing isolation rates for those species capable of producing chromosomal beta-lactamases was observed. Simultaneously, a small increase in the isolation frequency of non-chromosomal beta-lactamase-producing strains was noted and no correlation with cephalosporin usage was demonstrated. The trend toward predomination in the hospital environment of strains possessing substantial cephalosporin resistance has implications for future antimicrobial policy, choice of empiric therapy and the predictive value of standard antimicrobial susceptibility tests.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Humans; Western Australia

Antimicrobial activity of cefonicid, a new second generation cephalosporin, against 315 hospital isolates (4th trimester 1984) was investigated. E. coli and Proteus mirabilis were the most susceptible species. All E. coli strains except one were inhibited at 8 mg/l (modal MIC: 0.5); MICs of all indole + Proteus were 8 mg/l (modal MIC: 0.06). Another group was moderately susceptible: MICs of Klebsiella and Citrobacter ranged from 0.12 to 128 mg/l, but MICs of 50% of these strains were less than or equal to 4 mg/l; MIC was less than or equal to 8 mg/l for 75% of indole + Proteus and Providencia strains; tested Proteus vulgaris were especially resistant (MICs greater than 128 mg/l). Most Enterobacter and Serratia strains showed little susceptibility (modal MIC for both species greater than or equal to 128 mg/l). MICs of all tested Pseudomonas aeruginosa strains were greater than 128 mg/l. 20 of the 24 tested Acinetobacter strains had a MIC of greater than or equal to 128 mg/l. For Staphylococcus aureus, 88% of methicillin-sensitive strains were inhibited by concentrations of 2 to 4 mg/l whereas methicillin-resistant strains were resistant to cefonicid (75%: MIC greater than 64 mg/l). Enterococci were resistant to cefonicid. A correlation curve was established (Enterobacteria and Staphylococci). On the basis of cefonicid's pharmacokinetic characteristics, critical concentrations are proposed.

Topics: Bacteria; Cefamandole; Cefonicid; Cross Infection; Enterobacteriaceae; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Staphylococcus aureus

Topics: Bacteria; Cefamandole; Cefonicid; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cross Infection; Humans; Microbial Sensitivity Tests

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cross Infection; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis

Topics: Anti-Bacterial Agents; Cefamandole; Cephalosporins; Cephamycins; Cross Infection; Humans; United States

In an eight year period 16 cases of serious extrapulmonary Hemophilus influenzae infection in adults were identified, including cases of meningitis, pericarditis, epiglottitis, empyema, cellulitis, osteomyelitis, endometritis, urinary tract infection, orbital cellulitis, primary peritonitis, mesenteric lymphadenitis and aortic graft infection. An 18 month prospective study of H. influenzae infection in hospitalized adults identified 10 cases of bronchitis, 25 of pneumonia and 65 of respiratory tract colonization, but there were no extrapulmonary infections. In 29 percent of the respiratory tract infections, H. influenzae appeared to be a nosocomial pathogen; in 71 percent, the infection was mixed. Finally, 110 clinical isolates of H. influenzae were studied for antimicrobial susceptibility. Eight percent were ampicillin resistant, two strains were resistant to tetracycline and one to chloramphenicol, but all were susceptible to trimethoprim-sulfamethoxazole and cefamandole.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefamandole; Cross Infection; Drug Resistance, Microbial; Female; Haemophilus Infections; Haemophilus influenzae; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim

Topics: Adult; Brazil; Cefamandole; Cefoxitin; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Israel; Male; Proteus Infections; Providencia; South Africa; Transients and Migrants