8-YEAR EXPERIENCE WITH CEFUROXIME FOR ANTIMICROBIAL PROPHYLAXIS IN CARDIOTHORACIC SURGERY

There have been reports from some institutions that the long-term use of cephalosporins for surgical prophylaxis has resulted in the emergen ce of cephalosporin-resistant staphylococci that may be responsible fo r postoperative wound infections. At the St. Vincent Hospital and Heal th Care Center, 10,488 patients who underwent cardiothoracic surgery b y a single surgical team between 1985 and 1992 and who received antimi crobial prophylaxis with cefuroxime have been evaluated for the develo pment of postoperative wound infections. All patients received cefurox ime, 1.5 g every 12 hours, for 48 hours beginning within 60 minutes of the initial incision. Patients were monitored for at least 1 year. Sa mples of any purulent discharge were submitted for microbiologic analy ses. Annual wound infection rates ranged from 3.4% to 4.7%. Annual sup erficial sternal wound infection rates ranged from 2.3% to 3.0% and ac counted for over 60% of the infections. Annual deep sternal wound infe ction rates ranged from 0.3% to 1.7%. No changes in the susceptibility patterns to cefuroxime were observed for strains of Staphylococcus au reus, Staphylococcus epidermidis, or gram-negative bacilli. At our ins titution, the long-term use of cefuroxime for antimicrobial prophylaxi s in cardiothoracic surgery has not been associated with an increase i n the incidence of postoperative wound infections or the emergence of cefuroxime-resistant staphylococcal species.