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Ann Thorac Surg 1990;49:435-439
© 1990 The Society of Thoracic Surgeons

Articles

Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: A prospective study

Michael S. Gelfand, MD*, Bryan P. Simmons, MD, Philip Schoettle, MD, Oscar B. Harrington, MD, Frank Martin, MD, Edmond W. Owen, MD, Rebecca B. Craft, RN, Naseem Amarshi, PharmD

Departments of Medicine, Cardiovascular Surgery, and Pharmacy, Methodist Hospital, Memphis, Tennessee USA

Accepted for publication November 17, 1989.

* Address reprint requests to Dr Gelfand, 188 S Bellevue, Suite 420, Memphis, TN 38104.

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infec0tion, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.




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