Tamayo Eduardo, Gualis Javier, Flórez Santiago, Castrodeza Javier, Eiros Bouza José María, Alvarez Francisco Javier
Department of Anaesthesiology and Reanimation, Valladolid University Hospital, Valladolid, Spain.
J Thorac Cardiovasc Surg. 2008 Dec;136(6):1522-7. doi: 10.1016/j.jtcvs.2008.05.013.
Use of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance, lower costs, and fewer problems with drug toxicity and superinfections. We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures.
This random, prospective, clinical study included 838 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both. These patients were randomly given a single dose of cefazolin (2 g) or a 24-hour treatment (2-g initial dose, followed by 1 g every 8 hours). Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria. Patient clinical and demographic characteristics were noted, with follow-up for 12 postoperative months. The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively.
A total of 419 patients received single-dose cefazolin, and another 419 received the 24-hour treatment. Surgical site infection occurred in 35 (8.3%) patients receiving single doses and 15 (3.6%) patients administered the 24-hour treatment (P = .004). We identified no differences between groups for mortality or duration of hospitalization (preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention). The microorganisms isolated showed a similar distribution in both groups. The germs isolated were gram-positive cocci in 86% of the surgical site infections.
Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour, multiple-dose cefazolin regimen.
使用单剂量抗生素预防与降低抗生素耐药性、降低成本以及减少药物毒性和二重感染问题相关。我们检验了以下假设：单剂量头孢唑林在预防接受心脏手术的成人手术部位感染方面与24小时头孢唑林治疗方案同样有效。
这项随机、前瞻性临床研究纳入了838例接受择期冠状动脉搭桥术、瓣膜手术或两者皆有的成年患者。这些患者被随机给予单剂量头孢唑林（2克）或24小时治疗（初始剂量2克，随后每8小时1克）。对药物治疗方案不知情的研究者根据疾病控制与预防中心的标准诊断伤口感染。记录患者的临床和人口统计学特征，并进行术后12个月的随访。主要目的是比较术后12个月内两组手术感染的发生率。
共有419例患者接受单剂量头孢唑林治疗，另外419例接受24小时治疗。接受单剂量治疗的患者中有35例（8.3%）发生手术部位感染，接受24小时治疗的患者中有15例（3.6%）发生手术部位感染（P = .004）。我们发现两组在死亡率或住院时间（术前住院时间、重症监护病房停留时间和手术干预后的住院时间）方面没有差异。分离出的微生物在两组中的分布相似。在86%的手术部位感染中分离出的病菌为革兰氏阳性球菌。
在心脏手术中用作抗生素预防的单剂量头孢唑林与24小时多剂量头孢唑林治疗方案相比，手术部位感染率更高。
