cefamandole and Postoperative-Complications

A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery. It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups. Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia. The dose was determined according to the patient's weight: 1.5 g for patients weighing less than 60 kg, 2.5 g for those weighing between 60 and 80 kg, and 3 g for those above 80 kg. Group B patients (n = 55) were given a placebo at the same times. Nineteen other patients were excluded because either the tumour was found to be infected, or the patient had to be mechanically ventilated postoperatively, or an exploratory thoracotomy only was carried out, or they were allergic to beta-lactam antibiotics. The efficacy of antibiotic prophylaxis was assessed by recording the incidence of postoperative infections, the length of the patient's stay in hospital, and the need to use an antibiotic treatment. Patients, their sputum and wound were examined every day, and their temperature recorded. The white blood cell count and chest X-ray was carried out every day for the first week. All the drain and catheter tips were cultured, as well as sputum and blood (every three days). In case of infection, samples were obtained and cultured. Both groups of patients were similar with regard to age, risk factors (smoking habit, diabetes mellitus), and type of surgery (segmentectomy, lobectomy, pneumonectomy). There were 9 postoperative infections in group A, and 22 in group B (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Bacterial Infections; Cefamandole; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Pneumonectomy; Postoperative Complications; Prospective Studies

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Cefamandole; Cesarean Section; Drug Therapy, Combination; Female; Gentamicins; Humans; Parametritis; Penicillins; Postoperative Complications; Pregnancy; Preoperative Care; Puerperal Infection

An open, randomised clinical trial was performed on 435 high risk patients who underwent open cholecystectomy between 1 = January 1993. and 31. December 1995. The patients were divided into three groups. Group 1 (AMOX/CLAV, N = 179) was treated with 1.2 g i.v. amoxicillin/clavulanic acid, the patients in Group 2 (COMPARATOR, N = 164) were given other antibiotics commonly used for prophylaxis in biliary surgery (cefamandole, cefuroxime, cefotaxim). Group 3 (CONTROL, N = 92) contained patients without any risk factors for infectious complication. In this group we did not use antibiotic prophylaxis. The results were analysed with Student t, and x2 methods. The wound infection rate in Group 1 was 2.76% versus 5.48% in Group 2. The difference was significant if the patients were older than 65 years or the preoperative hospitalisation was longer than 5 days. The concentration of amoxycillin/calavulanic acid was measured in the serum, in the wall of the gall bladder, in the bile obtained both from the gall bladder and the major bile duct. The observed levels were higher than the therapeutic concentration in the serum and in the bile gained from the major bile duct, whereas lower in the gall bladder wall, and in the bile gained from the gall bladder. Systemic antibiotic prophylaxis is required for open cholecystectomy in high risk patients.

Topics: Age Factors; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefamandole; Cefotaxime; Cefuroxime; Cephalosporins; Cholecystectomy; Clavulanic Acid; Drug Therapy, Combination; Female; Humans; Length of Stay; Male; Middle Aged; Penicillins; Postoperative Complications; Reoperation; Risk; Risk Factors; Surgical Wound Infection; Treatment Outcome

Infections are still the most frequent postoperative complications and one of the limiting factors of successful gynaecological surgery. In recent years information on successful anti-microbial chemoprophylaxis is increasing and is associated with reduced postoperative inflammations, febrile morbidity and early complications. Views differ above all as regards indications for the use of antibiotic prophylaxis and the selection of a suitable antibiotic. Data in the literature differ also as regards achieved results. The submitted work had the objective to test on a representative group the success and rationality of medicamentous prophylaxis in gynaecological surgery and to contribute to a clearer view on controversial points. 203 women admitted to the Second Gynaecological and Obstetric Department of the First Medical Faculty Charles University and General Faculty Hospital Prague for elective abdominal or vaginal hysterectomy on account of a benign indication were divided into three groups which did not differ from the demographic or medical aspect. In group A (53 women) for prophylaxis two doses of Augmentin were used (combination of amoxycillin with clavulanic acid) i.v., patients in group M (50 women) had three doses of Mandol (Cefamandol) i.m., and in control group K (100 patients) no antibiotics were administered prophylactically. The authors investigated the postoperative course and evaluated some parameters in relation to possible postoperative infectious complications. The results proved unequivocally that prophylaxis with Augmentin reduces significantly the postoperative infectious morbidity (11.5%), febrile morbidity (5.6%) and the incidence of early infectious complications (3.8%) after abdominal or vaginal hysterectomy, as compared with the control group (35%, 31% and 11% resp.). Prophylaxis with Cefamandol reduced only in few parameters postoperative complications, but in general did not lead to a significant improvement of the postoperative course nor to a reduction of postoperative inflammatory complications. Similar results were obtained when only complications after abdominal hysterectomy were evaluated. The results of bacteriological examination confirmed the expected differences in the spectrum of efficacy of the two antibiotics on the most common microbial flora in the given area, i.e. a high sensitivity of Augmention to enterococci and bacterioids and resistance of these bacteria to Mandol. These results can be considered one of the re

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bacterial Infections; Cefamandole; Cephalosporins; Drug Therapy, Combination; Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

Antibiotic prophylaxis is currently recommended in clean-contamined surgery (type II of Altemeier classification). Pulmonary surgery belongs to this type. This prospective randomized and controlled study was designed to compare amoxicillin and cefamandole for prevention of pleural and bronchopulmonary infections after pulmonary resections. It included 256 patients, admitted between October 1st 1989 and July 1st 1991, for elective thoracotomy and probable pulmonary resection. The patients were allocated into two groups, group A (amoxicillin) and group C (cefamandole). The first intravenous antibiotic injection took place immediately after induction of anaesthesia (1 g of amoxicillin or 1.5 g of cefamandole). Postoperative injections were performed every 6 hours during 36 hours (i.e. a total of 6 injections). Infection was defined by the association of general signs including hyperthermia (> 38 degrees C), hyperleucocytosis (> 12,000/mm3), and local signs such as bronchitis (B), pneumonia (P), empyema (E), wound sepsis (W) and non thoracic infection (S). Follow-up included the hospital stay and a period of eight months after surgery for possible rehospitalisation for infection. Respiratory infections (bronchitis n = 35, pneumonia n = 5, empyema n = 2) occurred in 18% of the total population. No difference was seen between the two groups concerning the type of infection and the repartition of infection in relation to the type of pulmonary surgery. The causative bacterial organisms were Haemophilus influenzae (n = 4), Streptococcus pneumoniae (n = 2), Escherichia coli (n = 1), anaerobic bacteria (n = 1). Multiple bacteria were found in one case. The empyema and wound sepsis occurred in the amoxicillin group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Cefamandole; Double-Blind Method; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Respiratory Tract Infections; Surgical Wound Infection

A controlled randomized trial was carried out in 324 patients with inguinal hernia. Efficacy was evaluated of a single injection of cefamandole (n = 162) administered at operative site during local anesthesia, using an untreated group as control (n = 162), as prophylaxis against post-operative local infection. Seven patients in the control group developed abscesses at the operative site after discharge, 6 of the 7 during one-month follow up, compared with none in the treated group (n = 0.07). No side effects were reported due to the antibiotic therapy. The cost of the antibiotic treatment was 10 times less than that for treating the suppurations in the control group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Local; Bacteremia; Cefamandole; Child; Drug Evaluation; Escherichia coli Infections; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Postoperative Complications; Staphylococcal Infections; Streptococcal Infections

We report the results of a randomized, prospective study devised to assess the effectiveness of perioperative cefamandole prophylaxis on the remote infections rate in neurosurgery. Only two kinds of neurosurgical procedures were studied: shunt placement and craniotomy for brain tumour. In the treated patients cefamandole 1.5 g was given one hour before surgery, then repeated twice eight hourly. When the surgical procedure lasted more than three hours cefamandole 1.5 g was administered throughout the operation. No case of local infection was observed in either group, and the percentage of patients with remote infections was the same in both groups. Leucocytosis and temperature were measured during 15 days following the surgical procedure, and there were no differences between the treated and untreated groups in the evolution of these parameters. This study does not suggest that routine perioperative antibiotic prophylaxis is mandatory in neurosurgery.

Topics: Adolescent; Adult; Aged; Bacteremia; Brain Neoplasms; Cefamandole; Female; Humans; Lung Diseases; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Prospective Studies; Urinary Tract Infections; Wound Infection

A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery. It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups. Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia. The dose was determined according to the patient's weight: 1.5 g for patients weighing less than 60 kg, 2.5 g for those weighing between 60 and 80 kg, and 3 g for those above 80 kg. Group B patients (n = 55) were given a placebo at the same times. Nineteen other patients were excluded because either the tumour was found to be infected, or the patient had to be mechanically ventilated postoperatively, or an exploratory thoracotomy only was carried out, or they were allergic to beta-lactam antibiotics. The efficacy of antibiotic prophylaxis was assessed by recording the incidence of postoperative infections, the length of the patient's stay in hospital, and the need to use an antibiotic treatment. Patients, their sputum and wound were examined every day, and their temperature recorded. The white blood cell count and chest X-ray was carried out every day for the first week. All the drain and catheter tips were cultured, as well as sputum and blood (every three days). In case of infection, samples were obtained and cultured. Both groups of patients were similar with regard to age, risk factors (smoking habit, diabetes mellitus), and type of surgery (segmentectomy, lobectomy, pneumonectomy). There were 9 postoperative infections in group A, and 22 in group B (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Bacterial Infections; Cefamandole; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Pneumonectomy; Postoperative Complications; Prospective Studies

During June 1985 through October 1986, 292 patients considered to be at high risk for having postoperative complications develop underwent cholecystectomy and were evaluated in a multicenter, randomized, prospective, double-blind study. Risk factors included age greater than 70 years, acute cholecystitis within the previous six months, obstructive jaundice, obesity and diabetes mellitus. One gram of cefamandole was administered intravenously to 144 patients and 148 patients received 1 gram of cefotaxime intravenously 30 minutes prior to skin incision. Culture-proved bactibilia was found in 55 patients and 11 of the patients had choledocholithiasis. Of the risk factors considered to place patients at high risk for postoperative infectious complications, obesity and acute cholecystitis proved to be the more common. However, age greater than 70 years, diabetes mellitus and obstructive jaundice were more significant risk factors predisposing to bactibilia. The most common organisms isolated from the bile and gallbladder intraoperatively were Staphylococcus, Streptococcus and Klebsiella species along with enterococcus, Escherichia coli and diphtheroids. Clinically significant postoperative infections occurred in eight patients, including six patients in the cefamandole group and two patients in the cefotaxime group. Antibiotic concentrations were measured in the serum, muscle, subcutaneous fat, gallbladder and bile, with cefamandole showing statistically significant greater concentrations in bile, gallbladder and muscle tissue. There was no statistical significance between the postoperative infection rates, total period of hospitalization or total hospital charges for each group. Therefore, there is no significant advantage between a single prophylactic dose of cefamandole versus cefotaxime for high-risk patients undergoing biliary tract operation.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bacteria; Bile; Biliary Tract Surgical Procedures; Cefamandole; Cefotaxime; Cephalosporins; Cholecystectomy; Double-Blind Method; Female; Gallbladder; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Risk Factors

Postoperative fibrinoid reactions are regarded as a localized form of endophthalmitis caused by microbial contamination of the capsular bag during intraocular lens implantation. The incidence of early fibrinoid reactions within the first 6 postoperative days following extracapsular cataract extraction was examined after intraocular administration of antibiotics vs placebo. In a double-blind randomized trial, 2 mg cefamandol or a placebo was administered in a 0.4-ml volume at the end of the operation. A group of 28 patients received the antibiotic (mean age 74.6 years; 15 f, 13 m), while 33 patients received the placebo (mean age 72,1 years; 21 f, 12 m). Fibrinoid reactions were observed in 8 out of 61 patients during the first 6 postoperative days. There was no significant difference between the antibiotic group and the placebo group (P = 0.31). We were unable to reduce the incidence of fibrinoid reactions although we had selected a broad-spectrum cephalosporin for antibiotic treatment. The results give rise to the suspicion that most of the early postoperative fibrinoid reactions we observed were not caused by contamination with bacteria of low pathogenicity.

Topics: Cefamandole; Double-Blind Method; Endophthalmitis; Fibrin; Humans; Injections; Lenses, Intraocular; Postoperative Complications

In this multicentre study, 883 evaluable patients undergoing orthopedic surgery were randomly assigned to receive antiinfective prophylaxis with either ceftriaxone (Rocephin) or cefamandole. 25 patients in the ceftriaxone group and 29 patients in the cefamandole group (5.6 vs 6.5%) presented with infectious complications within the first 60 days after surgery. Delayed deep wound infections developed in only 1 of 435 patients in the ceftriaxone group compared with 4 of 413 patients in the cefamandole group. Both drugs were well tolerated. The infection rate was twice as high after surgery in conventional operating theatres than after treatment in hypersterile operating theatres (3.3 vs 6.5%); this difference is not statistically significant.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone Diseases; Cefamandole; Ceftriaxone; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multicenter Studies as Topic; Muscular Diseases; Postoperative Complications; Premedication

Two hundred twenty-three women were given a single, 1-g, intravenous dose of cefamandole or cefotaxime at elective abdominal hysterectomy in a multicenter, prospective, randomized, blind clinical trial of efficacy and safety. The demographic, surgical, efficacy and safety variables were statistically similar. Prior to discharge from the hospital, 12 women (5.3%) developed major postoperative pelvic infections that required parenteral antimicrobial therapy; no wound infections occurred. There was no correlation between a depressed antimicrobial development of significant postoperative infection. An expanded spectrum of antibacterial activity and a longer serum half-life did not improve clinical efficacy, and single-dose intravenous cephalosporin prophylaxis before abdominal hysterectomy was associated with a low incidence of pelvic infection.

Topics: Adult; Cefamandole; Cefotaxime; Drug Evaluation; Female; Humans; Hysterectomy; Middle Aged; Pelvic Inflammatory Disease; Postoperative Complications; Prospective Studies; Random Allocation; Wound Infection

From July 1, 1978 to June 30, 1984, 45 radical abdominal hysterectomies were performed by the authors at Tripler Army Medical Center. Management was uniform except for the use of prophylactic antibiotics. Three patterns of practice were identified: Group I, no antibiotics were used; Group II, intravenous (i.v.) antibiotics were given in the induction room and for less than 48 h post-surgery; Group III, prophylactic i.v. antibiotics were given and the surgical site was also irrigated with a cefamandole and saline solution. The three groups were found to be similar with regard to age, parity, weight-height index, pre- and postoperative hematocrit, pre-operative white blood cell count, operative and anesthesia times, estimated blood loss, and amount of blood transfused. Groups I and II had a higher surgical site infection rate (87.5% and 63.6%, respectively) than Group III (3.8%). The mean 10-day fever index in degree hours was 109 for Group I, 71 for Group II, and 30 for Group III (P less than 0.001). Irrigation of the surgical site with a cefamandole and saline solution in addition to i.v. antibiotics decreases the infectious morbidity of radical hysterectomy.

Topics: Adenocarcinoma; Administration, Topical; Adult; Bacterial Infections; Carcinoma, Squamous Cell; Cefamandole; Clinical Trials as Topic; Doxycycline; Female; Humans; Hysterectomy; Lymph Node Excision; Middle Aged; Postoperative Complications; Premedication; Therapeutic Irrigation; Uterine Cervical Neoplasms

Fiscal considerations prompted comparison of cefotaxime (a third generation cephalosporin) with cefamandole (a second generation cephalosporin) for prophylaxis in the surgical treatment of the biliary tract. One hundred and eight patients who underwent an operation upon the biliary tract received three 1 gram doses of cefotaxime (54 patients) or cefamandole (54 patients) at induction of anesthesia and then one and three hours later. The study was prospective, blinded and randomized. The groups (cefotaxime versus cefamandole) were statistically comparable for age, sex, diagnosis, type and duration of operation and positive cultures. The most prevalent bacteria isolated from qualitative aerobic and anaerobic cultures of bile and the wall of the gallbladder were Escherichia coli, Streptococcus and Klebsiella. The incidence of bactibilia in patients with one of these conditions was: 75 per cent for cancer; 69 per cent for patients more than 60 years old; 33 per cent for jaundice; 58 per cent for pancreatitis; 60 per cent for exploration of the common bile duct, and 22 per cent for acute cholecystitis. Microbiologic agar diffusion assays of tissue from the wall of the gallbladder, subcutaneous fat and rectus muscle and samples of bile and serum obtained 30 minutes after the second dose of antibiotic showed a statistically significant greater concentration of cefamandole in the wall of the gallbladder. Otherwise there was no difference between the concentration of cefamandole and cefotaxime. The groups showed no statistical difference for temperature of more than or equal to 38 degrees C. on two consecutive measurements, postoperative wound and urinary infections, postoperative hospital stay and days in the intensive care unit and incidence of readmission within a month. Prophylactic use of cefotaxime in a three dose regimen provided no advantage in prophylaxis compared with cefamandole.

Topics: Adult; Aged; Bile; Biliary Tract Surgical Procedures; Cefamandole; Cefotaxime; Cholecystectomy; Clinical Trials as Topic; Costs and Cost Analysis; Double-Blind Method; Female; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Tissue Distribution

One hundred thirty-five patients undergoing vaginal hysterectomy were randomly assigned to one of three regimens of prophylactic antibiotics. There was no statistically significant difference among the three groups in the incidence of postoperative pelvic cellulitis, fever index, or duration of hospitalization. A single preoperative dose of cefazolin was as effective as three perioperative doses of cefazolin or a single dose of cefonicid in preventing postoperative infectious morbidity.

Topics: Adult; Cefamandole; Cefazolin; Cefonicid; Cephalosporins; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Infections; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Risk

A total of 337 patients undergoing coronary artery bypass grafting or cardiac valve replacement were randomly assigned to receive cefazolin (1 g every 8 h [q8h]), cefamandole (2 g q6h), or cefuroxime (1.5 g q12h) as an intravenous antibiotic prophylaxis. All drugs were administered within 60 min before the initial incision and were continued for 48 h postoperatively. No adverse effects related to the study drugs were observed. The percentage of patients with postoperative infection was 9% for the cefazolin group, 6% for the cefamandole group, and 5% for the cefuroxime group or 6.5% overall. There were more infection sites in patients treated with cefazolin than in those treated with cefuroxime (P = 0.05) or cefamandole (P = 0.06). Fewer wound infections occurred with cefuroxime (P less than 0.01) and cefamandole (P = 0.06) than with cefazolin. Analyses of the prophylactic regimens used in this study showed cefazolin and cefuroxime to be less costly than cefamandole.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Costs and Cost Analysis; Double-Blind Method; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Random Allocation

A prospective, randomized study was carried out to evaluate two antibiotic prophylactic regimens for patients undergoing cardiac surgery with cardiopulmonary bypass. Each patient of the first group (cefazolin) received four intravenous injections of 1 g cefazolin during 12 hours, patients of second (cefamandole), four doses of 750 mg. 155 patients scheduled for cardiac operation were included in the study. (May 1983 to April 1984). Patients were not admitted to the study in case of emergency, if their weight was less than 20 kg, if they had received antibiotics during the week before surgery or if they had a history of anaphylactic reactions to cephalosporins. There were no differences between the two groups on age, weight, height, sex, previous history of infectious disease, surgery and intensive care. There were no significant differences between the two groups in minor infections. The rate of urinary tract infection by streptococci was significatively higher (p less than 0.02) in the cefamandole group (38.3%) than in the cefazolin group (17.6%). There were no major infections (septicemia, mediastinitis, endocarditis). Patients temperature was the same during the first four postoperative days. Hospital stay was the similar in the two groups. The two antibiotics are similarly effective to prevent major infections in cardiac surgery. However cefazolin was preferred for antibiotic prophylaxis in cardiac surgery because of the higher rate of streptococcal urinary infections in patients given cefamandole.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Double-Blind Method; Extracorporeal Circulation; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation

A randomized, prospective, double-blind study was designed to compare intravenous administration with intrauterine irrigation using an extended half-life (t1/2 = three hours) cephalosporin, ceforanide. Patients included in the study had a nonelective cesarean section with rupture of membranes for three hours or longer. Sixty-four patients received a single dose of ceforanide immediately after clamping the umbilical cord. Patients were similar in both groups in age, weight, length of labor, and duration of ruptured membranes. The group receiving the intravenous ceforanide had a significantly shorter duration of surgery than the patients receiving the intrauterine ceforanide. Endometritis infection rates were similar, 11.8% (intravenous) versus 11.1% (intrauterine), P greater than .1. Serum levels were as much as tenfold higher in the intravenous group versus the intrauterine group. Intrauterine irrigation with an antimicrobial agent provided no advantage over systemic administration.

Topics: Adult; Cefamandole; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Female; Humans; Injections, Intravenous; Postoperative Complications; Pregnancy; Premedication; Random Allocation; Risk; Therapeutic Irrigation; Urinary Tract Infections; Uterus

Fifty-one premenopausal women were given perioperative intravenous antimicrobial prophylaxis at vaginal hysterectomy in a prospective, blinded comparative study. Febrile morbidity developed in 14 women (27.4 per cent), but only nine (17.6 per cent) required antimicrobial treatment. The incidence of postoperative pelvic infection was 19.2 per cent for 26 women given 200 milligrams of doxycycline preoperatively and 16 per cent for 25 women given 5 grams of cefamandole in four doses over a period of 18 hours. Infections were polymicrobial, usually occurred during the initial hospitalization and significantly prolonged hospital stay (p less than 0.01). No variables were identified that allowed prediction of infection. A single dosage of doxycycline was as effective at preventing posthysterectomy pelvic infection as were multiple dosages of cefamandole.

Topics: Adult; Age Factors; Cefamandole; Clinical Trials as Topic; Double-Blind Method; Doxycycline; Drug Evaluation; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Menopause; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Surgical Wound Infection

Two hundred twenty-three women who underwent cesarean section delivery were studied to assess the effectiveness of operative antibiotic irrigation in preventing postoperative uterine infection. Patients were prospectively randomized into high-risk and low-risk groups according to length of labor, and received irrigation with either a 2 gm solution of cefamandole or normal saline solution, or no irrigation. Infection rates of 48.6% and 54.8% were observed in high-risk patients given either saline solution or no irrigation, respectively. Three of 27 high-risk patients (11.1%) given antibiotic irrigation developed metritis. The authors find this method of preventing infection to be advantageous in terms of both efficacy and minimization of antibiotic exposure.

Topics: Anti-Bacterial Agents; Cefamandole; Cesarean Section; Female; Humans; Infection Control; Infections; Labor, Obstetric; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation; Risk; Therapeutic Irrigation; Time Factors; Uterine Diseases

Cefamandole in combination with tobramycin was evaluated in the treatment of peritonitis as an adjunct to laparotomy and performance of the indicated surgical procedure in 88 patients. The clinical response was judged satisfactory in 91 per cent. Of four deaths, only one could be attributed to infection. Side effects noted were decreased creatinine clearance in 16 patients, increased liver enzymes in ten patients, and eosinophilia in nine patients. Microbiologic studies revealed aerobic peritonitis in 44 cultures and anaerobic in 32. Eighty-five per cent of the gram-negative and 69 per cent of the gram-positive strains were susceptible to cefamandole. Cefamandole alone or in combination with tobramycin appears to be an effective and safe antibiotic when used in appropriate doses for the treatment of bacterial peritonitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Laparotomy; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Risk; Tobramycin

From 1979 through 1981, 152 patients with penetrating injuries of the intra-abdominal gastrointestinal tract were placed on one of three different perioperative antibiotic regimens in a prospective randomized fashion. The three regimens were A) cefamandole 2 grams every 4 hours, B) cefoxitin 2 grams every 6 hours, and C) ticarcillin 3 grams every 4 hours and tobramycin 1.5 mg/kg every 8 hours. Antibiotics were administered intravenously before and for 48 hours following surgical exploration and repair. The three treatment groups were similar with respect to age, average number of organ injuries, and distribution of organ injuries. Cefoxitin-treated patients experienced uneventful recoveries more often than cefamandole-treated patients (94% vs. 80.3%, p less than 0.05) when the incidence of gram-negative wound infection and intra-abdominal abscess formation was considered, while the number of patients who experienced uneventful recoveries in the ticarcillin-tobramycin group was not statistically different from the other two groups of patients. Bacteroides fragilis was isolated from three of the six abscesses occurring in the cefamandole-treated group, while no anaerobes were isolated from abscesses in patients treated with either of the other two regimens. The results of this study suggest that the most effective perioperative antibiotic regimen for patients with penetrating gastrointestinal wounds should possess activity against both aerobic and anaerobic flora of the bowel.

Topics: Abdomen; Abdominal Injuries; Abscess; Adult; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ticarcillin; Tobramycin; Wounds, Penetrating

Two hundred twenty patients were randomly assigned to receive either ceforanide or cephalothin as perioperative antibiotic prophylaxis during cardiovascular surgery. More infections were seen among cephalothin recipients (8 deep, 32 total) than among ceforanide recipients (1 deep, 17 total). Among patients who had only coronary artery bypass grafting, more cephalothin recipients had infection than did ceforanide recipients (19 of 82 as opposed to 7 of 83; p = 0.001; relative risk, 2.7; 95% confidence interval, 1.22 to 6.18). The difference between the two regimens was attributable to fewer blood, wound, and urinary tract infections. Among patients who had other procedures, there was no difference in the efficacy of the two regimens. Cephalothin recipients who developed wound or blood stream infections had lower antibiotic levels in their atrial appendages than recipients not developing such infections (p = 0.02). If one assumes that cephalothin does not increase the risk of infection, then these data show that antibiotic prophylaxis prevents infection after coronary artery bypass surgery, and, in the dosages used, that ceforanide is superior to cephalothin.

Topics: Cefamandole; Cephalothin; Clinical Trials as Topic; Coronary Artery Bypass; Double-Blind Method; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Myocardium; Postoperative Complications; Premedication; Random Allocation; Respiratory Tract Infections; Risk; Sepsis; Surgical Wound Infection; Urinary Tract Infections

The role of prophylactic antibiotic lavage in elective biliary tract operations is controversial. To investigate this question, a prospective, randomized study was undertaken between 1979 and 1983. All patients more than 18 years of age who underwent elective biliary operations were included. Eighty-eight patients were enrolled in the study and were stratified into the following antibiotic groups: (1) cefamandole nafate 2 gm administered intravenously preoperatively and 6 hours postoperatively in four doses; (2) cefamandole nafate 0.4% solution: 250 ml to irrigate the abdominal wound on opening, 500 ml to irrigate the peritoneal cavity, and 250 ml to irrigate the wound on closing; and (3) systemic plus topical administrations as in Nos. 1 and 2. Age, sex, type of operation, and underlying diseases were comparable in all groups. The patients were then evaluated for postoperative infections. In the intravenous cefamandole group there was only one patient who developed a urinary tract infection after operation. In the topical cefamandole group there were four postoperative infections: wound-one, urinary tract--two, and cholangitis--one. In the intravenous plus topical cefamandole group there were four postoperative infections: wound--one, urinary tract--two, and pneumonia--one. No deaths occurred in any group. Blood, subcutaneous, and peritoneal drug levels were sampled 1 hour after opening and before closing. Therapeutic serum levels of cefamandole are 1 to 16 micrograms/ml and adequate serum levels were achieved in all groups. However, higher levels were obtained in the subcutaneous tissue and peritoneum when topical cefamandole was used. We conclude: (1) Topical cefamandole lavage alone is adequate prophylaxis in elective biliary operations and achieves comparable results as perioperative systemic administration; (2) topical cefamandole resulted in higher subcutaneous tissue and peritoneal levels than intravenous cefamandole and also achieved therapeutic serum levels; and (3) there is no advantage to the use of systemic plus topical antibiotics in elective biliary operations.

Topics: Administration, Topical; Adult; Aged; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Bile; Biliary Tract Surgical Procedures; Cefamandole; Cephalosporins; Drug Evaluation; Female; Humans; Injections, Intravenous; Intraoperative Care; Male; Middle Aged; Peritoneum; Postoperative Complications; Random Allocation; Risk; Therapeutic Irrigation

A randomized, double-blind, placebo-controlled study was done of a short course of cefamandole administered intravenously after cord clamping as prophylaxis in women undergoing primary nonelective cesarean section in a community hospital. Duration of labor equal to or more than 14 hours was the only significant risk factor between patients who had postoperative infectious morbidity and those who had none. Four of 43 patients (9.3%) who received cefamandole, as opposed to 13 of 47 (27.7%) who received the placebo, developed infections (p less than 0.05). This difference was reflected totally in the difference in endomyometritis development between the groups. The use of intraoperative culturing predicted infection in 4 of 13 patients in the placebo group who developed infections postoperatively. No adverse side effects were noted, and there were no cases of delayed serious infection.

Topics: Adult; Bacterial Infections; Cefamandole; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Intraoperative Period; Kentucky; Placenta; Postoperative Complications; Pregnancy; Premedication; Random Allocation; Surgical Wound Infection

Topics: Adult; Age Factors; Aged; Cefamandole; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Respiratory Tract Infections; Risk; Surgical Wound Infection; Tobramycin; Urinary Tract Infections

A double-blind, prospective and randomized clinical trial of the efficacy of antibiotic prophylaxis in gastroduodenal operations was studied in 39 patients over an 18 month period. All patients had clinical features that placed them at high risk for the development of postoperative wound or intraabdominal sepsis. In the placebo group of 20 patients seven gastric-related infections developed, while 1 of the 19 patients who received perioperative cefamandole had one gastric-related infection (p less than 0.01). The responsible microorganisms were those that are normal components of the oral or intestinal microflora. Nongastric-related infections and deaths did not differ significantly in the two study groups. The results of this study confirm the efficacy of the use of short-term perioperative antibiotic prophylaxis in patients undergoing gastroduodenal surgery for bleeding duodenal or gastric ulcer, obstructing duodenal ulcer, gastric ulcer or malignancy.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Double-Blind Method; Duodenum; Gastric Juice; Humans; Postoperative Complications; Premedication; Prospective Studies; Stomach; Surgical Wound Infection

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Rupture, Spontaneous

During an 18-month period, antibiotic prophylaxis in 120 patients undergoing closed tube thoracostomy was evaluated by a prospective, randomized double-blind technique. Forty-six subjects had sustained penetrating chest trauma. Either placebo (n = 60) or 1 gm/6 hours cefamandole (n = 60) was begun intravenously at the time of tube insertion and was continued intravenously or intramuscularly until the second day following tube removal. Cultures were taken of the pleural drainage, usually blood, at tube insertion, on tube removal, and on several occasions between those times. Antibiotic concentrations were determined biologically on the same specimens of pleural fluid as well as selectively on concomitant venous blood samples. Cultures were also obtained from all subsequent foci of infection, including the wound, any empyema, bronchial secretions, urine, or infected intravenous sites. Aerobic and anaerobic isolation and identification were carried out according to standard laboratory procedures with sensitivity testing (disc and tube dilution) only of the aerobes. Results demonstrated that infection of the lung and/or pleural space was eight times more common in the placebo groups (13.3%) than in the group receiving cefamandole (1.7%) (p less than 0.01). In addition, the single infection that developed despite use of the antibiotic was due to a susceptible organism. No major adverse drug reactions were noted.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Female; Humans; Male; Middle Aged; Pleura; Postoperative Complications; Premedication; Thoracic Surgery

A double-blind placebo-controlled experiment was performed in 100 patients in labor with membrane rupture to determine the bacteriologic effects of antibiotic prophylaxis. Each subject received either 2.0 g cefamandole or placebo after cord clamping and 4 and 8 hours later. The cefamandole group had significantly less endometritis, but did not have significantly fewer major complications. Amniotic fluid cultures of the 2 groups were similar, but uterine lavage cultures of the cefamandole group showed significant increases in enterococci and gram-negative aerobes and decreases in gram-positive anerobes and low virulence organisms (Staphylococcus epidermidis, lactobacilli, and diphtheroids). Although clinical problems did not regularly accompany these changes, it would be foolhardy to ignore them. Thus, when patients develop infection after antibiotic prophylaxis, the physician should check for infection with resistant organisms.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Cesarean Section; Double-Blind Method; Female; Humans; Placebos; Postoperative Complications; Pregnancy

Cefamandole nafate has been shown to have good in vitro activity against a wide spectrum of aerobic and anaerobic pathogens frequently isolated from women with obstetrical and gynecological infections. One hundred and twenty seven women with these infections were treated with cefamandole: 78 had post-cesarean section metritis; 24 acute pelvic inflammatory disease; 18 post-hysterectomy cuff cellulitis/abscess; and 7 had vulvar or abdominal wound abscesses. All but 13% of these women had either polymicrobial aerobic/anaerobic bacterial infections, or had an anaerobic infection alone. Of these 127 women, 116 responded to cefamandole administration alone, and in the other 11 chloramphenicol was added. Of these 11, surgical therapy was necessary to eradicate infection in six women. Phlebitis, mild to severe, was demonstrated in 14% of the women and responded to conservative measures. Of 402 bacterial isolates from these women, 94% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level. Anaerobic streptococci were the most common isolate and 94% of these organisms were sensitive at 32 microgram/ml. Of the 43 Bacteroides species isolated, 90% were susceptible at 32 microgram/ml; 84% of Bacteroides fragilis were susceptible ast this concentration. Data now presented indicate that cefamandole given alone is safe and effective for treatment of women with polymicrobial mixed aerobic/anaerobic pelvic infections and approximately 5% will require surgical therapy for eradication of these infections.

Topics: Aerobiosis; Anaerobiosis; Bacteria; Bacterial Infections; Bacteroides; Cefamandole; Cephalosporins; Cesarean Section; Chloramphenicol; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Phlebitis; Postoperative Complications; Pregnancy; Puerperal Disorders

Seventy-nine patients about to undergo cardiac operations were randomly allocated to two treatment groups in an attempt to reduce postoperative chest infections. The group receiving a short peroperative course of cefamandole, an antibiotic effective against both the pneumococcus and Haemophilus influenzae, had a significantly lower postoperative chest infection rate than the group receiving a 3-day course of cephradine, an antibiotic previously chosen to prevent intracardiac infection during the operation. By selecting an appropriate antibiotic it is possible, using a short peroperative course, to reduce the postoperative chest infection rate in patients undergoing cardiac operations.

Topics: Adult; Cardiac Surgical Procedures; Cefamandole; Cephalosporins; Cephradine; Endocarditis, Bacterial; Humans; Intraoperative Period; Postoperative Complications; Respiratory Tract Infections; Surgical Wound Infection; Urinary Tract Infections

The effectiveness of intrauterine irrigation with an antibiotic solution of cefamandole nafate in reducing the incidence of endometritis after cesarean section was studied in a prospective, double-blind fashion. Ninety patients who underwent cesarean section at Tripler Army Medical Center were divided into three equal groups. Each group received one of the following treatments at the time of operation: (1) intrauterine irrigation with the antibiotic solution, (2) irrigation with normal saline solution, or (3) no irrigation. The resulting incidences of endometritis were 0%, 26.7%, and 23.3%, respectively. Intrauterine irrigation with cefamandole nafate solution at the time of cesarean section significantly reduced the incidence of endometritis.

Topics: Cefamandole; Cephalosporins; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Postoperative Complications; Pregnancy; Prospective Studies; Risk; Sodium Chloride; Therapeutic Irrigation

Cefamandole nafate (CM) and cephalothin sodium (CP) were administered as prophylaxis in a randomized, prospective study to 30 consecutive patients undergoing prosthetic cardiac valve insertion. A single dose of 20 mg/kg was given intramuscularly during anesthesia induction, and serial plasma antibiotic concentrations, atrial muscle and cardiac valve tissue antibiotic levels, plasma bactericidal activity against pathogenic staphylococci, and infectious complications were determined and compared for the two drugs. Both antibiotics produced high plasma levels (>20 mug/ml 30 min after injection) which fell less than 25% during the period of cardiopulmonary bypass. However, CM levels were significantly higher at most time periods (P<0.05) than CP levels. CP levels were undetectable in atrial muscle from 14 of 15 patients and in valves from 10 of 15 patients. In contrast, CM bioactivity was found in all tissues. Differences in tissue antibiotic concentration could not be accounted for by differences in plasma concentrations or by CP tissue binding and were assumed to be caused by differences in penetration. Plasma bactericidal activity against staphylococci was equal for the two drugs (median titer, 1:16). No infections were seen in either group. CM appeared to be an effective and perhaps preferable prophylactic antibiotic for use during cardiac surgery.

Topics: Adolescent; Adult; Aged; Blood Bactericidal Activity; Cefamandole; Cephalosporins; Cephalothin; Clinical Trials as Topic; Drug Evaluation; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Myocardium; Postoperative Complications

The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia.. A single-center cohort study.. All consecutive patients undergoing cardiac surgery between January 2006 and July 2011.. None.. Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01-1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score ≥ 3).. Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cefamandole; Cohort Studies; Female; Humans; Logistic Models; Male; Middle Aged; Pneumonia; Postoperative Complications; Risk Assessment; Risk Factors

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Cefamandole; Female; Humans; Male; Pneumonia; Postoperative Complications; Risk Assessment

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchi; Cefamandole; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Microbial Sensitivity Tests; Pneumonectomy; Pneumonia, Pneumococcal; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Risk; Treatment Outcome

The recommended antibiotic prophylaxis by second-generation cephalosporins reduces the incidence of wound infection and empyema, but its effectiveness on postoperative pneumonias (POPs) after major lung resection lacks demonstration. We investigated risk factors and characteristics of POPs occurring when antibiotic prophylaxis by second-generation cephalosporin or an alternative prophylaxis targeting organisms responsible for bronchial colonization was used.. An 18-month prospective study on all patients undergoing lung resections for noninfectious disease was performed. Prophylaxis by cefamandole (3 g/24 h, over 48 hours) was used during the first 6 months, whereas amoxicillin-clavulanate (6 g/24 h, over 24 hours) was used during the subsequent 12 months. Intraoperative bronchial aspirates were systematically cultured. Patients with suspicion of pneumonia underwent bronchoscopic sampling for culture.. Included were 168 patients in the first period and 277 patients in the second period. The incidence of POP decreased by 45% during the second period (P = 0.0027). A significant reduction in antibiotic therapy requirement for postoperative infections (P = 0.0044) was also observed. Thirty-day mortality decreased from 6.5% to 2.9% (P = 0.06). Multivariate analysis showed that type of resection, intraoperative colonization, chronic obstructive pulmonary disease, gender, body mass index, and type of prophylaxis were independent risk factors of POP. A case control-study that matched patients of the two periods according to these risk factors (except for antibiotic prophylaxis) confirmed that the incidence of POP was lowered during the second period.. Targeted antibiotic prophylaxis may decrease the rate of POPs after lung resection and improve outcome.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchitis; Case-Control Studies; Cefamandole; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Education, Medical, Continuing; Female; Follow-Up Studies; France; Humans; Incidence; Lung Diseases; Male; Middle Aged; Multivariate Analysis; Pneumonectomy; Pneumonia, Bacterial; Postoperative Complications; Preoperative Care; Probability; Prospective Studies; Reference Values; Risk Assessment; Surgical Wound Infection; Survival Rate

A 87-year-old patient developed coagulation abnormality following hip surgery related to the prophylactic use of cefamandole. Cefamandole as others cephalosporins with a methyl-tetrazol-thiol lateral chain interferes with the vitamin K regeneration cycle as do oral anticoagulants. Therefore, the use of others antibiotics or systematic vitamin K1 supplementation or single dose of cefamandole is recommended for patients with renal failure or with malnutrition. Vitamin K1 supplementation is a simple method resulting in complete resolution of the coagulation disorder.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Cefamandole; Cephalosporins; Female; Femoral Neck Fractures; Hematoma; Hemorrhagic Disorders; Humans; Postoperative Complications; Vitamin K; Vitamin K Deficiency

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Aortic Aneurysm, Abdominal; Bacteremia; Cefamandole; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Pneumonia, Bacterial; Postoperative Complications

Antibiotics can be associated with hypoprothrombinaemic haemorrhages in risk patients. Risk factors are: poor nutrition, impaired liver- or renal function, coagulation depleting medical therapy or illness. Pathogenetically there is a vitamin K deficiency with reduction of vitamin K dependent clotting factors; mainly by decreased vitamin K synthesis in intestinal bacterias. In consequence every risk patient under antibiotics should receive vitamin K prophylactically and in a parenteral way, because of unreliable resorption in gastrointestinal tract. Prothrombin-time-monitoring is essential to recognize the hypoprothrombinemia in every risk patient under antibiotics.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Appendicitis; Cefamandole; Diverticulitis, Colonic; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Hypoprothrombinemias; Intestinal Perforation; Male; Ornidazole; Postoperative Complications; Premedication

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

Two patients are described with severe coagulation disturbances, in one instance leading to extensive skin bleeding, secondary to the use of cefamandole. This cefalosporin antibiotic carries the same N-methylthiotetrazole side chain as moxalactam. Pathogenetic mechanisms leading to hypoprothrombinemia, its prevention and treatment are discussed.

Topics: Aged; Amputation, Surgical; Cefamandole; Diabetic Angiopathies; Female; Hemorrhagic Disorders; Humans; Hypoprothrombinemias; Kidney Transplantation; Male; Middle Aged; Pneumonia; Postoperative Complications

Topics: Cefamandole; Humans; Infection Control; Postoperative Complications; Premedication

Topics: Adult; Bacterial Infections; Cefamandole; Cefonicid; Cefoxitin; Cesarean Section; Cost-Benefit Analysis; Female; Humans; Postoperative Complications; Pregnancy

A 44-year-old man with end-stage ischemic cardiomyopathy was supported with an intra-aortic balloon and The Penn State Heart (artificial) prior to orthotopic cardiac transplantation on the 14th hospital day. At the time of transplantation, intraoperative cultures of pericardial and mediastinal fluid showed growth of Trichosporon beigelii (cutaneum). Shortly thereafter the patient developed visceral dissemination of T beigelii with no associated skin lesions. He was treated with amphotericin B and rifampin, but postmortem examination showed persistent, disseminated infection.

Topics: Adult; Cefamandole; Heart Failure; Heart Transplantation; Heart, Artificial; Humans; Immunosuppressive Agents; Male; Mitosporic Fungi; Mycoses; Postoperative Complications; Premedication; Reoperation; Trichosporon

Infectious complications were studied in 14 patients who received heart-lung transplants at Stanford University Medical Center from March 1981 to November 1983. Twenty-nine infections occurred in 12 patients: 18 bacterial, nine viral, and two fungal. Sixteen (89 percent) of the bacterial infections occurred in the lung. Because of frequent colonization of the lower respiratory tract, the specificity of transtracheal aspiration and bronchoscopy was low. Empiric broad-spectrum antibiotic therapy was usually successful, and no patient died of bacterial infection. Cytomegalovirus infection occurred in six and herpes simplex virus infection in three patients. Two patients had invasive candidiasis at postmortem examination. This series emphasizes the importance of infection, particularly of the lung, in causing morbidity and mortality in heart-lung transplant recipients.

Topics: Adult; Antilymphocyte Serum; Bacterial Infections; Candidiasis; Cefamandole; Cyclosporins; Cytomegalovirus Infections; Female; Graft Rejection; Heart Transplantation; Heart-Lung Transplantation; Herpes Simplex; Humans; Lung Transplantation; Male; Methylprednisolone; Middle Aged; Pneumonia; Postoperative Care; Postoperative Complications; Premedication; T-Lymphocytes

Topics: Administration, Topical; Bacterial Infections; Cefamandole; Drainage; Escherichia coli Infections; Female; Humans; Hysterectomy; Parametritis; Postoperative Complications; Premedication; Random Allocation; Therapeutic Irrigation

The influence of cefamandole and vancomycin used for prophylaxis on the warfarin anticoagulation response in 60 cardiac valve replacement patients during the postoperative period is presented. Patients were divided into two groups, hyper-responders prothrombin time (PT) greater than or equal to 32 sec, 48 hr after the initial warfarin dose (GrIHR), or normal responders PT less than 32 sec (GrIINR). Fifteen patients (25%) were in GrIHR (PT 44.3 +/- 10.5) and 45 in GrIINR (21 +/- 5). Fourteen of the 15 GrIHR patients received cefamandole and 1 of the 15 GrIHR patients received vancomycin p less than 0.05, as prophylaxis. Warfarin sensitivity was assessed using a warfarin dose index (WDI) calculated in the initial postoperative period (WDIINT) and at discharge (WDIDIS). GrIHR patients had greater WDIINT and WDIDIS compared to GrIINR p less than 0.001. Baseline prothrombin time measured 8 hours prior to start of warfarin therapy (PTBL), was linearly correlated to the WDIINT with r = 0.8, p less than 0.001 in cefamandole patients only. The data suggests that cefamandole increases warfarin sensitivity early in the postoperative course of oral anticoagulation therapy, which may lead to excessively high prothrombin times with the possibility for serious bleeding.

Topics: Blood Coagulation; Cefamandole; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Hypoprothrombinemias; Male; Postoperative Complications; Postoperative Period; Premedication; Retrospective Studies; Surgical Wound Infection; Thromboembolism; Vancomycin; Warfarin

The enthusiasm for the use of peritoneal irrigation has waxed and waned since its introduction by Dr. Pierce in 1905. The purpose of this study was to devise a relatively low-cost irrigant that could be used for continuous intraperitoneal lavage, with the intent of decreasing abscess formation following surgical treatment for generalized bacterial peritonitis. A solution of 1 L of normal saline containing 50 mg erythromycin, 50 mg cefamandole, 500 U heparin, and 5 mEq KCl was proven in in vitro studies to be bactericidal to Peptococcus anaerobius and Clostridium perfringens, and bacteriostatic to Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus faecalis, and Bacteroides fragilis. In a prospective study 50 patients underwent peritoneal lavage with 36 L over 2 days. No lavage patients developed intraabdominal abscesses. In a control group of 44 patients seven patients (15.9%) developed postoperative abscesses.

Topics: Adult; Bacterial Infections; Cefamandole; Drug Combinations; Erythromycin; Heparin; Humans; In Vitro Techniques; Middle Aged; Peritonitis; Postoperative Complications; Prospective Studies; Therapeutic Irrigation

Topics: Adolescent; Adult; Bacterial Infections; Cefamandole; Cephalosporins; Cesarean Section; Female; Genital Diseases, Female; Humans; Middle Aged; Postoperative Complications

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cefuroxime; Cephalosporins; Female; Femur Head; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Premedication

Topics: Aged; Cefamandole; Cephalosporins; Humans; Male; Postoperative Complications; Prostatectomy; Prostatitis

The effectiveness of intrauterine irrigation during cesarean section with a solution of cefamandole nafate in reducing febrile morbidity was studied in a prospective double-blind fashion. Ninety patients who were undergoing cesarean section at Tripler Army Medical Center were randomized into three groups: (1) intrauterine irrigation with cefamandole nafate solution, (2) intrauterine irrigation with normal saline solution, and (3) no irrigation. Febrile morbidity was evaluated by means of a fever index. There was a statistically significant reduction in the fever index in the group that received intrauterine irrigation with cefamandole nafate. The incidences of clinically diagnosed endomyometritis in the three groups were 0%, 26.7%, and 23.3%, respectively. Prophylactic intrauterine irrigation with cefamandole nafate during cesarean section markedly reduces febrile morbidity, primarily by reducing the incidence of endomyometritis.

Topics: Cefamandole; Cephalosporins; Cesarean Section; Double-Blind Method; Endometritis; Female; Fever; Humans; Intraoperative Care; Postoperative Complications; Pregnancy; Prospective Studies; Puerperal Infection; Risk; Therapeutic Irrigation; Uterus

Sixty women with endometritis following cesarean section were treated with cefamandole (12 gm/day) alone. Specimens for culture were obtained by endometrial lavage and from peripheral blood. Minimum inhibitory concentrations were performed on anaerobes and enterococci by an agar dilution technique. Anaerobic organisms were isolated in 55 of 60 (91.7%) endometrial specimens. Bacteremia was documented in 12 patients (20%). Of 387 isolates from uterine cultures, 20 (5%) were resistant or had MIC's greater than or equal to 32 micrograms/ml. Ten patients (17%) were judged clinical failures and responded to additional antibiotics. Of 19 patients with Bacteroides fragilis or related species isolates in the uterus, three (15%) were judged as failures. Cefamandole was well tolerated and appears to be useful in the initial treatment of endomyometritis.

Topics: Adult; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cephalosporins; Cesarean Section; Endometritis; Enterobacteriaceae Infections; Female; Humans; Postoperative Complications; Pregnancy; Staphylococcal Infections; Streptococcal Infections

The experience with the cefamandole prophylaxis in 244 patients with open heart-surgery, and another 84 patients operated upon on prosthetic vascular reconstruction was evaluated. No case of endocarditis, sepsis or massive wound infection with infected prosthesis was found in the reviewed patients. Considering the fact that patients undergoing open heart-surgery and prosthetic vascular reconstruction are subjected to much more bacterial contamination than patients undergoing any other surgical procedure, the cephalosporin treatment (in our study cefamandole) should be considered the antibiotic of choice in preventing of infection during and after such surgical intervention.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cephalosporins; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Surgical Wound Infection

Topics: Bile Ducts; Cefamandole; Cephalosporins; Child; Child, Preschool; Enterobacteriaceae Infections; Female; Humans; Infant; Male; Postoperative Complications