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The Annals of Thoracic Surgery, Vol 49, 435-439, Copyright © 1990 by The Society of Thoracic Surgeons

ARTICLES

Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study

MS Gelfand, BP Simmons, P Schoettle, OB Harrington, F Martin, EW Owen, RB Craft and N Amarshi
Department of Medicine, Methodist Hospital, Memphis, Tennessee.

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 infection, 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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