A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery.

A blinded, randomized, prospective study of 38 chronic renal failure patients was done to evaluate perioperative antibiotics in the prevention of postoperative infection of vascular access prostheses. Expanded polytetrafluoroethylene (PTFE) hemodialysis grafts were placed either in radiocephalic (19) or femorosaphenous (19) position. Cefamandole or placebo was given intravenously 30 minutes prior to operation and six to 12 hours postoperatively. The overall infection rate for the group was 26.3 percent with two of 19 antibiotic-treated and eight of 19 placebo-treated patients developing an infection (p less than 0.04). Grafts placed in the thigh have a greater risk of intraoperative contamination and infection. Postoperative infection associated with implantation of hemodialysis prostheses was significantly reduced by perioperative antimicrobials.