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John C. Hall
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Trevor T. Nicholls
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Ann Thorac Surg 1993;56:916-922
© 1993 The Society of Thoracic Surgeons

Articles

Antibiotic prophylaxis in cardiac operations

John C. Hall, FRACS*, Keryn Christiansen, FRCPA, Martin J. Carter, FRACS, Mark G. Edwards, FRACS, Andrew J. Hodge, FRACS, Mark A. Newman, FRACS, Trevor T. Nicholls, FRACS, Jane Hall, RN

Division of Surgery, Royal Perth Hospital, Perth, Australia

Accepted for publication December 14, 1992.

* Address reprint requests to Dr Hall, Department of Surgery, Royal Perth Hospital, Wellington St, Perth 6000 Australia.

This clinical trial, which was composed of 1,031 adults undergoing cardiac operations, compared the efficacy of a single dose of 1 g of ceftriaxone with a 48-hour regimen consisting of flucloxacillin and gentamicin. There was no significant difference (p = 0.89) in the overall incidence of major infections: 30 of 515 patients (5.8%; 95% confidence interval, 5.4% to 6.2%) taking ceftriaxone and 29 of 516 patients (5.6%; 95% confidence interval, 5.2% to 6.0%) taking flucloxacillin and gentamicin. Subgroup analyses, with a lower statistical power, failed to show a significant difference between patients who received ceftriaxone and those who received flucloxacillin/ gentamicin: major sternal wound infections arose in 2.7% of the patients taking ceftriaxone versus 1.6% in those on the 48-hour regimen (p = 0.20) and major limb wound infections arose in 4.2% and 5.4%, respectively (p = 0.44). Single-dose prophylaxis was associated with fewer intravenous administrations (864 doses versus 9,570 doses) and cost less (A$17,248 versus A$78,510). Although the regimen that included gentamicin was associated with the greatest biochemical impairment of renal function, the overall toxicity for both groups was low. We conclude that a single dose of ceftriaxone provided cost-efficient prophylaxis for adults undergoing cardiac operations when compared with a 43-hour regimen of gentamicin and flucloxacillin. The general principle revealed by our data is that the short-term administration of an appropriate antibiotic regimen represents optimal prophylaxis for patients undergoing cardiac procedures.




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