COMPARISON OF VANCOMYCIN AND CEFUROXIME FOR INFECTION PROPHYLAXIS IN CORONARY-ARTERY BYPASS-SURGERY

OBJECTIVE: To investigate clinically significant differences between v ancomycin and cefuroxime for perioperative infection prophylaxis in co ronary artery bypass surgery. DESIGN: A total of 884 patients were ran domized prospectively to receive either cefuroxime (444) or vancomycin (440) and were assessed for infectious complications during hospitali zation and 1 month postoperatively. SETTING: A university hospital. RE SULTS: The overall immediate surgical-site infection rate was 3.2% in the cefuroxime group and 3.5% in the vancomycin group (difference, -0. 3; 95% confidence interval, -2.6-2.1). CONCLUSIONS: The data suggest t hat vancomycin has no clinically significant advantages over cephalosp orin in terms of antimicrobial prophylaxis. We suggest that cefuroxime (or first-generation cephalosporins, which were not studied here) is a good choice for infection prophylaxis in connection with coronary ar tery bypass surgery in institutions without methicillin-resistant Stap hylococcus aureus problems. In addition to the increasing vancomycin-r esistant enterococci problem, the easier administration and usually lo wer price of cefuroxime make it preferable to vancomycin (Infect Contr ol Hosp Epidemiol 1998;19:234-239).