Surgical prophylaxis: how far have we really come?

Appropriate use of antibiotic prophylaxis reduces the frequency of deep wound infections after clean surgery. However, there may be important differences in the prophylactic efficacy of various cephalosporins. The results of our study of patients undergoing cardiothoracic surgery indicate that cefazolin offers unreliable prophylaxis against S. aureus when compared to cefamandole. Differences in the prophylactic efficacy of these two agents may be due to differences in their stability to staphylococcal beta-lactamase.