[Postoperative infections in cardiovascular surgery: what is an appropriate prophylactic administration of antibiotics?].

Between June 1990 and March 1993, postoperative infections developed in 19 (7.6%) of 250 consecutive patients. All patients studied underwent cardiac or major vascular operations and survived more than four postoperative days. Respiratory and wound infections were the most common infections after operation. Organisms detected were Staphylococci in 11 of which 4 were methicillin resistant, gram negative rods in 6. Factors significantly associated with an increased risk of postoperative infections by univariate analysis included age (> or = 70 years), NYHA (Grade IV), diabetes mellitus, long operating time (> or = 320 min), long perfusion time (150 min), using of IABP. The ratio of postoperative infections in patients who were given broad spectrum penicillin was higher than others. The percentage of postoperative infections was 4.4% in single antibiotic group and 13.2% in double antibiotics group, the former was significantly lower than the later. It is concluded that single dose of first or second or fourth generation cephem was strongly recommended as prophylactic antibiotics after cardiovascular surgery. Twenty adult patients received 2 g of flomoxef (FMOX) in the priming solution of cardiopulmonary bypass just before operation. Serum FMOX levels in patients developed slowly and remained at high levels, showing 49.8 micrograms/ml after five hours. It seemed that no addition of drugs were necessary during cardiopulmonary bypass within five hours.