Prophylaxis in cardiac surgery. A controlled randomized comparison between cefazolin and cefuroxime

Area of Science:

• Infectious Diseases
• Cardiovascular Surgery
• Pharmacology

Background:

• Surgical site infections (SSIs) are a significant concern in cardiac surgery.
• Antibiotic prophylaxis is standard to reduce SSI risk.
• Comparing cefuroxime (CFX) and cefazolin (CFZ) for short-term prophylaxis in cardiac surgery is important.

Purpose of the Study:

• To compare the efficacy of short-term cefuroxime (CFX) versus cefazolin (CFZ) prophylaxis in preventing infections in patients undergoing elective cardiac surgery.
• To evaluate the incidence, type, and severity of surgical wound infections and secondary infections between the two antibiotic groups.

Main Methods:

• Prospective randomized two-center trial.
• 189 patients received cefuroxime (CFX) and 196 patients received cefazolin (CFZ).
• A total of 3 g of each antibiotic was administered over 24 hours.

Main Results:

• Sternal wound infections occurred in 8/189 patients with CFX (all minor) and 8/196 patients with CFZ (2 major, 6 minor).
• Secondary infections occurred less frequently with CFX (13.2/100) than CFZ (16.8/100).
• No major differences in clinical outcome, infection incidence, or identified organisms (Staphylococcus aureus, gram-negative organisms) were observed between groups.

Conclusions:

• Short-term administration of 3g CFX or CFZ over 24 hours provided suboptimal prophylaxis for wound and secondary infections in elective open-heart surgery.
• Neither antibiotic demonstrated a clear advantage over the other in this study.
• Further research into optimal antibiotic prophylaxis duration and regimens for cardiac surgery is warranted.