Antimicrobial prophylaxis in cardiovascular surgery.

Antimicrobial prophylaxis for cardiovascular surgery has a long history despite there being surprisingly little formal proof of the need for it. The stated aims of chemoprophylaxis are prevention of early prosthetic valve endocarditis (EPVE) and sternotomy infections after coronary artery bypass graft (CABG) surgery. Comparisons of narrow spectrum prophylaxis (flucloxacillin) and broad spectrum prophylaxis (cephradine) within a unit dedicated to open-heart surgery over a prolonged period suggest that narrow spectrum prophylaxis offers acceptably low levels of both infective complications whilst minimising colonisation of the patients with Gram-negative bacilli and yeasts. Some of the infective complications of open-heart surgery (intravascular catheter infections and urinary tract infections) are amenable to prevention by non-antibiotic means.