Cefamandole as a prophylactic in cardiac surgery

140 cases of patients requiring sternotomy incisions were divided into two groups receiving Penicillin/Flucloxacillin and Cefamandole prophylaxis. Pre- and post-operative and bypass circuit bacteriology was performed to determine the extent of contamination and infection with each regime after operations lasting 7 or more hours. Unexpectedly high contamination of the respiratory tract was observed in patients receiving Penicillin/Flucloxacillin prophylaxis. Significantly higher Slesser Intensive Therapy Unit stays were observed in 8 of these patients, 3 of whom succumbed to chest infection associated pathology. The 50% resistant organism rate in the Cefa group (Table IV) suggests that short sharp course prophylaxis (i.e. less than 48 hours) using wide spectrum antibiotics is effective and does not necessarily promote emergence of resistant organisms over or above that of any narrow spectrum antibiotic prophylaxis. Acceptably low wound infection rates in both groups suggests that wound healing (aided by iodine sprays topically before closure) is more dependent on closing technique than on type of antibiotic prophylaxis. The very similar bacteriaemia rates, with odd organisms, in both groups in the immediate post-operative period suggests that vigilance and frequent post-operative blood cultures are a surer policy in the prevention and treatment of early endocarditis than faith in any particular antibiotic prophylaxis.