Ann Thorac Surg 1987;43:544-549
© 1987 The Society of Thoracic Surgeons
Articles
Prophylactic Antibiotic Treatment Prevents Infection after Cardiopulmonary Bypass: A Study in Dogs
Willem van Oeveren, M.Sc,
Jacob Dankert, M.D.,
Walter Wildevuur*,
Charles R.H. Wildevuur, M.D., Ph.D.
From the Department of Cardio-Pulmonary Surgery, Research Division, and the Department of Hospital Epidemiology, Laboratory of Medical Microbiology, University Hospital, Groningen, The Netherlands
Accepted for publication August 25, 1986.
* Address reprint requests to Dr. Wildevuur, Department of Cardiopulmonary Surgery, Research Division, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands
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Abstract
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The effect of two prophylactic antibiotic regimens during cardiopulmonary bypass (CFB) was investigated in dogs. Airborne contamination was determined by spraying two different bacterial strains (Staphylococcus aureus and Serratia marcescens) into the air of the operating room. Dogs were operated on and underwent CPB with a bubble oxygenator. Pericardial suction, either conventional (blood-air) or selective (only blood), was used. Particularly in the first situation, an impaired humoral host defense is induced. In dogs given the regimen consisting of penicillin G (benzylpenicillin), gentamicin sulfate, and flucloxacillin, the number of contaminated sites for both bacteria was reduced (p < .01) compared with those given cefuroxime. The effectiveness of the combined antibiotic regimen could be ascribed to increased serum bactericidal activity and polymorphonuclear leukocyte (PMN) killing capacity. Cefuroxime enhanced the PMN respiratory burst. As a result, two weeks postoperatively the rate of infection was small in both groups. We conclude that prior to CPB, antibiotics should be administered prophylactically to overcome a period of impaired humoral host defense during CPB.
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Footnotes
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This work was supported by Grant No. 77.0874 from the Dutch Heart Foundation.
The assistance of Jetta Fahner and Wietske Postma for the bacteriological studies and of J. M. Elstrodt and D. Meyer for the operations is gratefully acknowledged.
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References
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- Blakemore WS, McGarrity GJ, Thurer RJ, et al. Infection by air-borne bacteria with cardiopulmonary bypass Surgery 1971;70:830.[Medline]
- Freeman R, Hjersing N. Bacterial culture of perfusion blood after open-heart surgery Thorax 1980;35:754.[Abstract/Free Full Text]
- Kluge RM, Calia FM, McLaughlin JS, Hornick RB. Sources of contamination in open-heart surgery JAMA 1974;230:1415.[Medline]
- Sutherland RD, Martinez HE, Guynes WA, et al. Postoperative chest wound infections in patients requiring coronary bypass J Thorac Cardiovasc Surg 1977;73:944.[Abstract]
- van Oeveren W, Dankert J, Boonstra PW, et al. Airborne contamination during cardiopulmonary bypass: the role of cardiotomy suction Ann Thorac Surg 1986;41:401.[Abstract/Free Full Text]
- van Oeveren W, Dankert J, Wildevuur CRH. Defense mechanism against infection after cardiopulmonary bypass in dogsIn: Schmid-Schönbein H, Wurzinger LJ, Zimmerman RE, editors. Enzyme Activation in Blood-Perfused Artificial Organs. Dordrecht: Martinus Nijhoff; 1985. pp. 225.
- van Oeveren W, Kazatchkine, MD, Descamps-Latscha B, et al. Deleterious effects of cardiopulmonary bypass: a prospective study of bubble versus membrane oxygenation J Thorac Cardiovasc Surg 1985;89:888.[Abstract]
- Nichols RL. Use of prophylactic antibiotics in surgical practice Am J Med 1981;70:686.[Medline]
- Dismukes WE, Karchmer AW, Buckley MJ, et al. Prosthetic valve endocarditis: analysis of 38 cases Circulation 1973;48:365.[Abstract/Free Full Text]
- Hillis DJ, Rosenfeldt FL, Spicer WJ, Stirling GR. Antibiotic prophylaxis for coronary bypass grafting J Thorac Cardiovasc Surg 1983;86:217.[Abstract]
- Archer GL, Armstrong BC. Alteration of staphylococcal flora in cardiac surgery patients receiving antibiotic prophylaxis J Infect Dis 1983;147:642.[Abstract/Free Full Text]
- Newson SWB. Antibiotic prophylaxis for open-heart surgery J Antimicrob Chemother 1978;4:389.[Free Full Text]
- Boonstra PW, van Imhoff GW, Eysrnan L, et al. Reduced platelet activation and improved hemostasis after controlled cardiotomy suction during clinical membrane oxygenator perfusions J Thorac Cardiovasc Surg 1985;89:900.[Abstract]
- Dankert J. Biotyping of enterobacteriaceae: a method to determine the efficacy of the barrier function of isolation unitsIn: Heneghan JB, editor. Germfree Research: Biological Effects of Gnotobiotic Environments. Academic: New York, London; 1973. pp. 59-67.
- Washington II JA, Sutter VL. Dilution susceptibility test: agar and macro-broth dilution proceduresIn: Lennette EH, Balows A, Hausler WJ, Truant JP, editors. Manual of Clinical Microbiology. Washington, DC: American Society of Microbiology; 1980. pp. 453-458.
- Weening RS, Roos D, Loos JA. Oxygen consumption of phagocytizing cells in human leukocytes and granulocyte preparations: a comparative study J Lab Clin Med 1974;83:579.
- Dankert J, Holloway Y, Schaareman M. A new anaerobic blood culture medium: laboratory evaluation Zentralbl Bakteriol [B] 1980;248:392.
- Anderson BR, Amirault HJ. Important variables in granulocytes chemiluminescence Proc Soc Exp Biol Med 1979;162:139.[Abstract/Free Full Text]
- Hirsch JG, Strauss B. Studies on heat-labile opsonin in rabbit serum J Immunol 1964;92:145.[Abstract/Free Full Text]
- Hauser WE, Remington JS. Effect of antibiotics on the immune response Am J Med 1982;72:711.[Medline]
- Prokesch RC, Hand WL. Antibiotic entry into human polymorphonuclear leukocytes Antimicrob Agents Chemother 1982;21:373.[Abstract/Free Full Text]
- Shafer RB, Hall WH. Bacterial endocarditis following open-heart surgery Am J Cardiol 1970;25:602.[Medline]
- Skinner DB, Myerowitz PD. Recent advances in the management of thoracic surgical infections (collective review) Ann Thorac Surg 1981;31:191.[Abstract/Free Full Text]
- Bryan CS, Smith Jr CW, Sutton JP, et al. Comparison of cefamandole and cefazolin during cardiopulmonary bypass J Thorac Cardiovasc Surg 1983;86:222.[Abstract]
- Goldmann DA, Hopkins CC, Karchmer AW, et al. Cephalothin prophylaxis in cardiac valve surgery J Thorac Cardiovasc Surg 1977;73:470.[Abstract]
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