Doebbeling B N, Pfaller M A, Kuhns K R, Massanari R M, Behrendt D M, Wenzel R P
Department of Medicine, University of Iowa College of Medicine, Iowa City.
J Thorac Cardiovasc Surg. 1990 Jun;99(6):981-9.
A prospective double-blind trial was performed at a tertiary care center to evaluate perioperative cephalosporin prophylaxis in cardiac operations. Patients were randomized to receive either cefazolin (n = 104) or cefuroxime (n = 109), the preoperative dose being given within 1 hour before the initial incision. Drugs were continued for 48 hours (cefazolin, 1 gm intravenously every 8 hours; cefuroxime, 1.5 gm intravenously every 12 hours). Postoperative infections were assessed by trained nurse clinicians, and data were analyzed by the intention-to-treat principle. Sternal wound infections or mediastinitis occurred in one of 104 patients treated with cefazolin and 10 of 109 treated with cefuroxime (p = 0.01). Deep sternal wounds (including mediastinitis and sternal osteomyelitis) occurred in none of the cefazolin-treated patients and five cefuroxime-treated patients (p = 0.06). Although overall nosocomial infection rates were similar (16.3 versus 19.3 per 100), wound infection occurred somewhat more frequently with streptococci (groups B and D) in patients receiving cefazolin (four versus zero, p = 0.110); conversely staphylococcal infections were more frequent in the cefuroxime group (seven versus one, p = 0.066). Mean and median postoperative stay was 1 day shorter in the cefazolin group. In contrast to findings of a previous report, our data indicate that cefazolin prevented more sternal wound infections than cefuroxime, a finding that supports prophylaxis with a first-generation cephalosporin.
在一家三级护理中心进行了一项前瞻性双盲试验，以评估心脏手术围手术期头孢菌素预防感染的效果。患者被随机分为两组，分别接受头孢唑林（n = 104）或头孢呋辛（n = 109）治疗，术前剂量在初次切口前1小时内给予。药物持续使用48小时（头孢唑林，每8小时静脉注射1克；头孢呋辛，每12小时静脉注射1.5克）。术后感染由经过培训的护士临床医生进行评估，并根据意向性分析原则对数据进行分析。接受头孢唑林治疗的104例患者中有1例发生胸骨伤口感染或纵隔炎，接受头孢呋辛治疗的109例患者中有10例发生（p = 0.01）。接受头孢唑林治疗的患者中无一例发生深部胸骨伤口感染（包括纵隔炎和胸骨骨髓炎），而接受头孢呋辛治疗的患者中有5例发生（p = 0.06）。虽然总体医院感染率相似（每100例中分别为16.3例和19.3例），但接受头孢唑林治疗的患者中，链球菌（B组和D组）引起的伤口感染略多（4例对0例，p = 0.110）；相反，头孢呋辛组葡萄球菌感染更为常见（7例对1例，p = 0.066）。头孢唑林组术后平均住院时间和中位住院时间均短1天。与之前一份报告的结果相反，我们的数据表明，头孢唑林预防胸骨伤口感染的效果优于头孢呋辛，这一发现支持使用第一代头孢菌素进行预防。
