RANDOMIZED, PROSPECTIVE COMPARISON OF FIRST-GENERATION AND 2ND-GENERATION CEPHALOSPORINS AS INFECTION PROPHYLAXIS FOR CARDIAC-SURGERY

Surgical wound infections after cardiovascular surgery may be life thr eatening and are resource intensive. Second-generation cephalosporins are purported to have a broader antimicrobial spectrum than first-gene ration cephalosporins and, therefore, may be more efficacious for infe ction prophylaxis. We have conducted a randomized prospective study of 702 patients undergoing open heart surgery to test the hypothesis tha t the second-generation cephalosporin, cefuroxime, will be more effica cious for infection prophylaxis than the first-generation cephalospori n, cefazolin. Patients were randomized to receive cefazolin 1 g intrav enously every 8 hours for 48 hours begun 1 hour preoperatively plus 1 g after 4 hours of surgery (8 doses, n = 425) or cefuroxime 1.5 g 1 ho ur prior to surgery plus 1.5 g every 12 hours for 3 additional doses ( 4 doses, n 277). Infection was defined as a draining wound with or wit hout a positive culture. There was no difference in the wound infectio n rate between the groups (p = 0.68). Chest wound infections occurred in 2.1% of patients treated with cefazolin and 2.9% of patients treate d with cefuroxime (p = 0.79). The rate of true mediastinitis requiring exploration and drainage was 0.7% in both groups (p = 0.84). Leg infe ctions occurred in 6.6% of cefazolin-treated patients and 5.6% of cefu roxime-treated patients (p = 0.83). The second-generation cephalospori n, cefuroxime, did not reduce the incidence of wound infection when co mpared with the first-generation cephalosporin, cefazolin. Since insti tutional antibiotic acquisition and administration costs vary, careful analysis of these factors will allow determination of the most cost-e ffective infection prophylaxis regimen in cardiac surgery.