Comparison of vancomycin and cefuroxime for infection prophylaxis in coronary artery bypass surgery.

OBJECTIVE

To investigate clinically significant differences between vancomycin and cefuroxime for perioperative infection prophylaxis in coronary artery bypass surgery.

DESIGN

A total of 884 patients were randomized prospectively to receive either cefuroxime (444) or vancomycin (440) and were assessed for infectious complications during hospitalization and 1 month postoperatively.

SETTING

A university hospital.

RESULTS

The overall immediate surgical-site infection rate was 3.2% in the cefuroxime group and 3.5% in the vancomycin group (difference, -0.3; 95% confidence interval, -2.6-2.1).

CONCLUSIONS

The data suggest that vancomycin has no clinically significant advantages over cephalosporin in terms of antimicrobial prophylaxis. We suggest that cefuroxime (or first-generation cephalosporins, which were not studied here) is a good choice for infection prophylaxis in connection with coronary artery bypass surgery in institutions without methicillin-resistant Staphylococcus aureus problems. In addition to the increasing vancomycin-resistant enterococci problem, the easier administration and usually lower price of cefuroxime make it preferable to vancomycin.