Sirinek K R, Schauer P R, Yellin A E, Berne T V, Heseltine P, Appleman M, Gill M, Pappa K A
Department of Surgery, University of Texas Health Sciences Center, San Antonio 78284-7842.
J Am Coll Surg. 1994 Apr;178(4):321-5.
The ideal regimen for the prevention of postoperative infections occurring after elective cholecystectomy has been widely debated. This double-blind, randomized study was conducted to compare the effectiveness and safety of cefuroxime with that of cefazolin in 295 patients undergoing elective cholecystectomy who were considered to be at high risk for postoperative infection. Patients were randomly assigned to receive either a single 1.5 gram dose of cefuroxime plus three doses of placebo, or four 1 gram doses of cefazolin. Each regimen was begun 30 to 60 minutes preoperatively and repeated every six hours for three doses postoperatively. Patients were evaluated during the hospitalization period and again at 30 days. All postoperative infections, including remote infections, were included in the definition of failure. Bacteriologic success rates were 95.5 percent in the cefuroxime group and 98.2 percent in the cefazolin group (p > 0.05). Corresponding clinical success rates were 91.4 and 94.9 percent (p > 0.05), respectively. There was no association between intraoperative bile cultures and the risk of failure or the type of microorganism isolated from postoperative infections. Both regimens were well-tolerated. In view of the additional costs and time associated with preparation and administration of multiple doses, a single preoperative 1.5 gram dose of cefuroxime may be a cost-effective alternative to four 1 gram doses of cefazolin in patients undergoing elective cholecystectomy who are at high risk for postoperative infection.
择期胆囊切除术后预防感染的理想方案一直存在广泛争议。本双盲随机研究旨在比较头孢呋辛与头孢唑林在295例择期胆囊切除且被认为术后感染高危患者中的有效性和安全性。患者被随机分配接受单剂1.5克头孢呋辛加三剂安慰剂，或四剂1克头孢唑林。每种方案均在术前30至60分钟开始，术后每6小时重复给药三次。在住院期间及30天时对患者进行评估。所有术后感染，包括远处感染，均纳入失败定义。头孢呋辛组细菌学成功率为95.5%，头孢唑林组为98.2%（p>0.05）。相应的临床成功率分别为91.4%和94.9%（p>0.05）。术中胆汁培养与失败风险或术后感染分离出的微生物类型之间无关联。两种方案耐受性均良好。鉴于多剂量制剂的制备和给药涉及额外成本和时间，对于择期胆囊切除且术后感染高危的患者，术前单剂1.5克头孢呋辛可能是四剂1克头孢唑林的一种具有成本效益的替代方案。
