ro13-9904 and Peripheral-Vascular-Diseases

Serious morbidity and mortality are associated with postoperative wound infections in peripheral vascular surgery. The use of prophylactic antibiotics is considered the standard of care, with attention focused on the most efficacious agent. A prospective, randomized study was conducted to evaluate the efficacy of ceftriaxone versus cefazolin in prevention of postoperative wound infections in a group of patients who had peripheral arterial operations between October 1991 and February 1993. Patient characteristics associated with an increased risk of postoperative wound infection were evaluated. Prophylaxis was provided for 105 operations with cefazolin and 103 operations with ceftriaxone. The overall wound infection rate was 3.85%. Six operations (5.7%) in the cefazolin group were complicated by wound infection versus 2 operations (1.9%) in the ceftriaxone group. Diabetes (6 infections/64 operations; infection rate, 9%) and a personal history of previous aortocoronary bypass (5 infections/49 operations; infection rate, 10%) were characteristics associated with an increased chance for postoperative wound infection. Ceftriaxone is therapeutically equivalent to cefazolin in the prevention of postoperative wound infections in peripheral vascular surgery.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arteries; Cefazolin; Ceftriaxone; Cephalosporins; Female; Humans; Incidence; Male; Middle Aged; Peripheral Vascular Diseases; Prospective Studies; Reoperation; Risk Factors; Surgical Wound Infection

To examine the effects of diabetes, vascular disease, age, and antimicrobial therapy on clinical outcomes, including amputation rates, in patients with osteomyelitis treated in the outpatient setting.. We performed a retrospective chart review of patients treated with intravenous antimicrobial therapy for osteomyelitis at an outpatient infectious diseases practice. All patients were followed for at least 6 months.. Four hundred and fifty-four patients qualified for inclusion, with follow-up information available for up to 10 years. One hundred and thirty-nine patients (31%) had recurrences and 27 (6%) had amputations. Of the recurrences, 108 (78%) occurred within 6 months and 132 (95%) within 1 year. In univariate analyses, peripheral vascular disease, diabetes, and the combination were all associated with the risk of recurrence; age (>70 years) was not. For osteomyelitis due to Staphylococcus aureus, the relative risk of recurrence, using a Cox regression model, was 0.8 for ceftriaxone (95% confidence interval [CI]: 0.4 to 1.5; P = 0.53), 1.1 for cefazolin (95% CI: 0.5 to 2.2; P = 0.80), and 2.5 for vancomycin (95% CI: 1.1 to 5.6; P = 0.04), as compared with the use of a penicillinase-resistant penicillin.. Diabetes and peripheral vascular disease are important factors in determining the prognosis of patients with osteomyelitis, but age is not. Almost all recurrences of osteomyelitis occur within 1 year. Recurrence rates with osteomyelitis associated with S. aureus appear to be higher with the use of vancomycin, whereas ceftriaxone and cefazolin appear to be similar to penicillinase-resistant penicillins.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Amputation, Surgical; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Child; Diabetes Complications; Female; Humans; Infusions, Intravenous; Male; Medical Records; Middle Aged; Osteomyelitis; Outcome Assessment, Health Care; Penicillins; Peripheral Vascular Diseases; Proportional Hazards Models; Recurrence; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis; Vancomycin; Washington

Topics: Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Diabetes Mellitus; Duplicate Publications as Topic; Humans; Osteomyelitis; Penicillins; Peripheral Vascular Diseases; Staphylococcal Infections