Edwards W H, Kaiser A B, Tapper S, Edwards W H, Martin R S, Mulherin J L, Jenkins J M, Roach A C
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Vasc Surg. 1993 Sep;18(3):470-5; discussion 475-6. doi: 10.1067/mva.1993.48123.
Recent studies of perioperative antimicrobial prophylaxis have indicated an improved efficacy of beta-lactamase-stable cephalosporins compared with cefazolin, the most commonly used prophylactic agent. Previous studies in our institution have revealed a superiority of cefamandole to cefazolin in patients undergoing heart surgery, although there was no difference between cefazolin and cefuroxime in patients undergoing peripheral vascular surgery. This study was therefore designed to compare cefamandole with cefazolin in wound infection prophylaxis in clean vascular surgery.
The study was conducted from August 1990 through May 1992 and consisted of 893 patients with aortic or infrainguinal arterial procedures randomized to receive either cefamandole or cefazolin.
The difference in infection rates associated with cefamandole versus cefazolin prophylaxis (3.2% vs 1.9%, respectively) was not significant (p = 0.42). A cost savings of approximately $95,000 per year at our institution favors the continued use of cefazolin over cefamandole. Risk factor analysis was carried out for preoperative and postoperative events that might have predisposed to infection. Only preoperative use of aspirin and the postoperative finding of a lymphocele correlated with a higher infection rate.
Cefazolin continues to be the most cost-effective antibiotic for prophylaxis in clean vascular surgical procedures.
近期围手术期抗菌药物预防的研究表明，与最常用的预防药物头孢唑林相比，β-内酰胺酶稳定的头孢菌素疗效更佳。我们机构之前的研究显示，在心脏手术患者中，头孢孟多优于头孢唑林，尽管在周围血管手术患者中，头孢唑林和头孢呋辛之间没有差异。因此，本研究旨在比较头孢孟多和头孢唑林在清洁血管手术中预防伤口感染的效果。
该研究于1990年8月至1992年5月进行，包括893例行主动脉或腹股沟下动脉手术的患者，随机接受头孢孟多或头孢唑林治疗。
头孢孟多与头孢唑林预防相关的感染率差异（分别为3.2%和1.9%）不显著（p = 0.42）。在我们机构，每年节省约95,000美元的费用，这有利于继续使用头孢唑林而非头孢孟多。对可能易导致感染的术前和术后事件进行了危险因素分析。只有术前使用阿司匹林和术后发现淋巴囊肿与较高的感染率相关。
在清洁血管手术预防中，头孢唑林仍然是最具成本效益的抗生素。
