Cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery

Area of Science:

• Infectious Diseases
• Pharmacology
• Cardiovascular Surgery

Background:

• Surgical site infections (SSIs) are a significant concern in cardiac and major vascular surgery.
• Antibiotic prophylaxis is crucial for preventing SSIs in these high-risk procedures.
• Cefuroxime and ceftriaxone are commonly used antibiotics for surgical prophylaxis.

Purpose of the Study:

• To compare the efficacy and safety of cefuroxime versus ceftriaxone for antibiotic prophylaxis in patients undergoing cardiac and major vascular surgery.
• To evaluate infection rates, lethality, and specific infection types (septicaemia, pneumonia) between the two antibiotic groups.
• To assess plasma concentrations of ceftriaxone and their adequacy in relation to minimum inhibitory concentrations (MICs).

Main Methods:

• A randomized, prospective study involving 512 patients undergoing cardiac (n=418) and major vascular surgery (n=94).
• Patients received either a 2-day course of cefuroxime (1.5g every 12h) or ceftriaxone (2g IV followed by 1g IV after 24h).
• Infection rates, lethality, and specific infections were monitored for one month. Plasma ceftriaxone levels were measured in a subset of patients.

Main Results:

• The overall one-month lethality rate was 1.0%.
• The total infection rate was 4.7% (12/258 in cefuroxime group vs. 12/254 in ceftriaxone group).
• Septicaemia occurred in 1.4% (4 vs. 3 patients) and pneumonia in 2% (5 vs. 5 patients). One case of Clostridium difficile-associated diarrhea was reported.

Conclusions:

• Both cefuroxime and ceftriaxone prophylaxis were highly effective in preventing infections after major cardiovascular surgery.
• Achieved plasma levels of ceftriaxone exceeded MICs for common pathogens, suggesting adequate prophylaxis with a single dose for most patients.
• Further investigation into single-dose ceftriaxone prophylaxis may be warranted for major cardiovascular surgery.