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

Author(s): Vuorisalo S, Pokela R, Syrjala H

Affiliation(s): Department of Surgery, University of Oulu, Finland. Sailaritta.Vuorisalo@fimnet.fi

Publication date & source: 1998-04, Infect Control Hosp Epidemiol., 19(4):234-9.

Publication type: Clinical Trial; Randomized Controlled Trial

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.