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Prospective randomised comparison of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery
S M Nooyen1, B P Overbeek, A Brutel de la Rivière
1Department of Anaesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
A single dose of cefuroxime is as effective as a three-day course for preventing wound infections after coronary artery bypass grafting (CABG). This antibiotic prophylaxis strategy simplifies treatment without compromising patient safety or outcomes.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) following coronary artery bypass grafting (CABG).
- Optimizing antibiotic regimens aims to maximize efficacy while minimizing resistance and patient burden.
Purpose of the Study:
- To evaluate the non-inferiority of single-dose cefuroxime versus a three-day course for antibiotic prophylaxis in CABG patients.
- To compare the incidence of wound infections between the two prophylactic regimens.
Main Methods:
- Prospective randomized controlled trial involving 1,016 patients undergoing CABG.
- Patients received either a single intravenous dose or a three-day course of cefuroxime.
- Wound infection rates (sternal and donor sites) were compared between groups.
Main Results:
- A total of 844 patients were evaluable for efficacy.
- Sternal site infection rates were 14% for single-dose and 13% for three-day course (p > 0.05).
- Donor site infection rates were 38% for single-dose and 39% for three-day course (p > 0.05).
Conclusions:
- Single-dose cefuroxime prophylaxis is as effective as a three-day course in preventing wound infections after CABG.
- This finding supports the use of simplified, single-dose antibiotic regimens in cardiac surgery.
Abstract:
To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting, 1,016 consecutive patients were prospectively randomized to receive either a single dose or a three-day course of cefuroxime. Nine patients (0.9%) died within seven days; no death was caused by infection. For various reasons 163 other patients were not evaluable. Therefore, 844 patients were evaluated. Patients in group A (n = 419) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia; group B (n = 425) received the same dose followed by 750 mg t.i.d. for three consecutive days. Both groups were comparable regarding all risk factors. The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups. No significant differences in wound infection were observed between the two treatment groups: sternal site infection in the single-dose prophylaxis group was 14% versus 13% in the three-day course group; donor site infection occurred in 38% versus 39%. It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection.