Outcome Analysis of Antimicrobial Prophylaxis in Cardiothoracic Surgery Patients Receiving Cefazolin Alone or a Ceftazidime—Vancomycin Combination

Abstract

Although cefazolin is recommended as the drug of choice for most cardiothoracic surgeries, some surgeons prefer a broad-spectrum prophylactic regimen. The purpose of this observational study was to compare the infection rates in a cohort of male patients undergoing heart, lung, and thoracic aneursym surgeries from 1995 to 1998 at a single institution who received cefazolin, ceftazidime plus vancomycin (broad-spectrum), or other antibiotics for antimicrobial prophylaxis. Data were collected for 648 patients over more than 2 years. Infection rates were not different (p = 0.5) between the cefazolin (14%) and the broad-spectrum antibiotic groups (11%). The incidences of mediastinitis were also not different between the cefazolin and broad-spectrum groups. There was a statistically shorter length-of-stay in the ICU (p = 0.0109) in the cefazolin group (median 2.0 days) compared with the broad-spectrum group (median 3.0 days) when phases I and II were combined. Multiple logistic regression suggests that antibiotics were changed more often in the patients who received cefazolin instead of ceftazidime plus vancomycin. Other variables associated with the need to change antibiotics include surgeon, open-heart surgery, diabetes, and hospital stay greater than 1 day. These data convinced the cardiac surgeons at this institution to use cefazolin as the drug of choice for cardiothoracic surgery antibiotic prophylaxis.