cefamandole and Heart-Diseases

A relatively large number of comparative trials of antibiotic prophylaxis in cardiac surgery have been published, many of which have serious design flaws. Despite the large number of studies, no single antibiotic regimen has emerged as clearly superior in preventing postoperative site infections. To determine if a superior regimen could be identified with a study designed to avoid flaws found in previous studies, we undertook a randomized, double-blind clinical trial of three cephalosporins. From March 1987 to February 1990, 2759 adults underwent median sternotomies: 1641 completed study participation, 203 were enrolled but were dropped from the study for protocol violations, and 815 were excluded. The characteristics of all 2759 patients were recorded with respect to case mix and infection risk factors, and the patients were followed-up by the same nurse throughout hospitalization and for 6 weeks after discharge for the assessment of infection outcome status. Of the 1641 participants, 141 (8.6%) had one or more operative site infections: 46 of 549 (8.4%) cefamandole recipients, 46 of 547 (8.4%) cefazolin recipients, and 49 of 545 (9.0%) cefuroxime recipients (p = 0.92). The sites of infection and the depth of tissue involvement were not significantly different across groups. Because no differences in effectiveness in preventing postoperative site infections were demonstrated in a rigorously designed trial, the costs of the drugs, including the costs of their preparation and delivery, may be the only variables by which to choose among these three antibiotic prophylaxis regimens.

Topics: Adult; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Cefuroxime; Double-Blind Method; Female; Heart Diseases; Humans; Male; Premedication; Research Design; Risk Factors; Sternum; Surgical Wound Infection

To determine the incidence, the mortality, the risk factors and the most appropriate method for treatment of sternal infections, 9,742 charts were reviewed retrospectively of patients having undergone a sternotomy for cardiac surgery at the Montreal Heart Institute. One hundred and eleven sternal infections (1.1%) were identified: 55 (0.57%) superficial, 56 (0.57%) profound (mediastinitis). The treatment for these profound infections was either debridement, open or closed with drainage irrigation, pectoral flap closure-repair, or epiplooplasty closure. The risk factors for those patients experiencing profound infections were diabetes, obesity, length of the surgical intervention, the time spent in the operating room, and the duration of endotracheal intubation. Eleven of the 111 patients died. The average length of hospitalization were similar for those patients treated by pectoral flap repair and by the epiplooplasty closure. All patients (100%) treated by the epiplooplasty closure developed an epigastric hernia. Six cases of recurrent infection were observed in the group treated by debridement. The average hospital stay was shortened for those patients benefiting from the pectoral flap and epiplooplasty closures. A high incidence of mortality is associated with profound sternal infection. The methods of treatment are various. We recommend as treatment of choice, the pectoral flap closure because there is relatively low risks with this procedure, little to no recurrence of infection, a shorter hospital stay and this procedure does not provoke epigastric hernia.

Topics: Adult; Aged; Cefamandole; Drainage; Female; Heart Diseases; Humans; Incidence; Male; Mediastinitis; Middle Aged; Multivariate Analysis; Osteotomy; Postoperative Complications; Preoperative Care; Retrospective Studies; Staphylococcal Infections; Sternum; Surgical Flaps

To assess the predictive value of preoperative surveillance cultures for the postoperative development of Staphylococcus aureus wound infection, the findings in 563 patients who underwent elective cardiac surgery were evaluated. One hundred and forty-seven (26%) were found to be S. aureus carriers preoperatively. Postoperatively, 11 S. aureus wound infections developed, 4 in patients whose cultures were positive preoperatively and 7 in patients whose cultures were negative preoperatively. The patient's endogenous flora appears to be the source of only a minority of such postoperative infections. The authors conclude that preoperative surveillance cultures are not of value in predicting patients at risk for wound infection after elective cardiac surgery.

Topics: Adolescent; Adult; Cefamandole; Cephalothin; Child; Child, Preschool; Female; Follow-Up Studies; Heart Diseases; Humans; Infant; Male; Middle Aged; Premedication; Preoperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection