A comparative study of cefamandole and ceftriaxone as prophylaxis in cardiac surgery

Summary We compared the prophylactic use of cefamandole and ceftriaxone in 40 patients undergoing elective cardiac surgery. Postoperative wound infection occurred in one and two patients, respectively, in each group (n. s.), and bronchial superinfection in one patient in each group. In 12 additional patients drug concentrations in plasma and pericardial fluid were measured at different times following the administration of ceftriaxone. Plasma and pericardial fluid concentrations of ceftriaxone were above the minimal inhibitory concentration of susceptible microorganisms for up to 24 h after intravenous administration. We conclude, firstly, that the incidence of infection after cardiac surgery is low with both cefamandole and ceftriaxone prophylaxis. Secondly, efficient plasma and pericardial fluid levels of ceftriaxone last for up to 24 h after intravenous administration.

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Cefamandol und Ceftriaxon als Prophylaxe bei herzchirurgischen Eingriffen: eine vergleichende Studie

Zusammenfassung In einer prospektiven, randomisierten Studie verglichen wir bei 40 herzchirurgischen Patienten Cefamandol und Ceftriaxon als Infektionsprophylaxe. Bei weiteren 12 Patienten wurden Plasma- und perikardiale Flüssigkeitsspiegel von Cefamandol in verschiedenen Zeitabständen nach dessen Verabreichung bestimmt. Eine postoperative Wundinfektion wurde bei einem, respektive zwei Patienten in jeder Gruppe (Cefamandol-Ceftriaxon) beobachtet, und eine bronchiale Superinfektion bei je einem Patienten. Die Plasma- und perikardialen Flüssigkeitsspiegel für Ceftriaxon waren weit über der minimalen inhibitorischen Konzentration für alle auf Ceftriaxon ansprechende Erreger, selbst 24 h nach intravenöser Verabreichung. Wir ziehen die Schlußfolgerung, daß erstens die Infektionsrate nach herzchirurgischen Eingriffen sowohl mit Cefamandolals auch mit Ceftriaxon-Prophylaxe sehr gering ist und zweitens auch 24 h nach Ceftriaxon-Verabreichung noch bakterizide Konzentrationen im Plasma und in der perikardialen Flüssigkeit vorliegen.

     

A double-blind comparative study of prophylactic antibiotic therapy in open heart surgery: penicillin G versus vancomycin

A double-blind clinical study was carried out comparing the prophylactic effectivity of penicillin G with vancomycin in 113 adult patients undergoing open heart surgery. Eighty of these underwent valve replacement. A total of 14 of 52 penicillin-treated patients (26.9%) and 5 of 61 vancomycin-treated patients (8.2%) suffered from postoperative infection (0.005 less than p less than 0.02). Five patients in the penicillin group and none in the vancomycin group developed postoperative wound infection (0.01 less than p less than 0.02). No significant differences in blood culture and sepsis, tracheal culture and clinical respiratory tract infection, urine culture and clinical urinary tract infection, and colonization rate were found between the 2 groups. No cases of prosthetic valve endocarditis were diagnosed. Bacteriologic culture and resistance studies did not reveal significant changes concerning the resistance patterns; in particular, the emergence of a vancomycin-resistant strain of Staphylococcus albus was not seen. A decrease in the colonization rate with Staphylococcus albus from 53% in 1975 to 1977 to 34.6% and 31.1% in the penicillin and vancomycin groups, respectively, was found in the following 2 years.     

Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center

Background

Due to the popularity of video-assisted thoracic surgery (VATS) techniques in clinical, thymoma patients via VATS thymectomy are increasing rapidly. However, compared with open thymectomy, the potential superiorities and defects of VATS thymectomy remain controversial.

Methods

A number of 129 patients who underwent thymectomy of early stage thymoma (Masaoka stage I and stage II) in one single center from January 2007 to September 2013 were selected in this retrospective study. Of those patients, 38 thymoma patients underwent VATS thymectomy (VATS group) and 91 underwent open thymectomy (open group) via either transsternal [44] or transthoracic approach [47] in the same period. The postoperative variables, which included postoperative hospital length of stay (LOS), the intensive care unit (ICU) LOS, the entire resection ratio, the number of thoracic drainage tubes, the quantity of output and duration of drainage, were analyzed. Meanwhile, the operation time and blood loss were considered as intraoperative variables.

Results

All thymoma patients in the analysis included 19 thymoma patients with myasthenia gravis, among which five patients via VATS thymectomy and 14 patients via open thymectomy respectively. There was no death or morbidity due to the surgical procedures perioperatively. The ICU LOS, operation time, entire resection ratio, and the number of chest tubes were not significantly different in two groups. The postoperative hospital LOS of VATS thymectomy was shorter than that of open thymectomy (5.26 versus 8.32 days, P<0.001). The blood loss of VATS thymectomy was less than open thymectomy (114.74 versus 194.51 mL, P=0.002). Postoperatively, the quantity of chest tubes output in VATS group was less than that in open thymectomy group (617.86 versus 850.08 mL, P=0.007) and duration of drainage in VATS group was shorter than that in open thymectomy group (3.87 versus 5.22 days, P<0.001).

Conclusions

VATS thymectomy is a safe and practicable treatment for early-stage thymoma patients. Thymoma according with Masaoka staging I-II without evident invading seems to be performed through VATS approach appropriately, which has shorter postoperative hospital LOS, less blood loss and less restrictions to activities, hence patients will recover sooner.     

Improvisation versus guideline concordance in surgical antibiotic prophylaxis: a qualitative study

Purpose

Surgical antibiotic prophylaxis (SAP) is a common area of antimicrobial misuse. The aim of this study was to explore the social dynamics that influence the use of SAP.

Methods

20 surgeons and anaesthetists from a tertiary referral hospital in Australia participated in semi-structured interviews focusing on experiences and perspectives on SAP prescribing. Interview data were analysed using the framework approach.

Results

Systematic analysis of the participants’ account of the social factors influencing SAP revealed four themes. First, antibiotic prophylaxis is treated as a low priority with the competing demands of the operating theatre environment. Second, whilst guidelines have increased in prominence in recent years, there exists a lack of confidence in their ability to protect the surgeon from responsibility for infectious complications (thus driving SAP over-prescribing). Third, non-concordance prolonged duration of SAP is perceived to be driven by benevolence for the individual patient. Finally, improvisation with novel SAP strategies is reported as ubiquitous, and acknowledged to confer a sense of reassurance to the surgeon despite potential non-concordance with guidelines or clinical efficacy.

Conclusions

Surgical-specific concerns have thus far not been meaningfully integrated into antimicrobial stewardship (AMS) programmes, including important dynamics of confidence, trust and mitigating fear of adverse infective events. Surgeons require specific forms of AMS support to enact optimisation, including support for strong collaborative ownership of the surgical risk of infection, and intra-specialty (within surgical specialties) and inter-specialty (between surgery, anaesthetics and infectious diseases) intervention strategies to establish endorsement of and address barriers to guideline implementation.

     

Short-duration,single-agent antibiotic prophylaxis for meningitis in trans-sphenoidal surgery

Perioperative bacterial meningitis after trans-sphenoidal surgery for pituitary and parasellar lesions is an uncommon but serious complication. Little evidence guides the choice of chemoprophylaxis in this setting. To begin to address this deficiency, we investigated the incidence of perioperative meningitis in 442 patients who underwent trans-sphenoidal surgery and received a short chemoprophylaxis regimen with a single agent and did not require lumbar drainage. In 2005 we instituted a standardized antibiotic prophylaxis protocol for trans-sphenoidal surgery that utilized intravenous cefuroxime, a second-generation cephalosporin with broad coverage and excellent spinal fluid penetration, administered 30 min before surgery and 8 h later. The primary endpoint was the incidence of perioperative (within 30 days of surgery) bacterial meningitis. Data from The Barrow Pituitary Outcomes Project, a prospectively maintained patient research database, were supplemented with review of medical records and hospital discharge codes. There were no cases of perioperative meningitis. Three patients developed delayed meningitis associated with persistent or recurrent spinal fluid leakage 2–8 months after surgery. Perioperatively, seven patients received additional antibiotics for urinary tract infections. A single-agent, short-duration chemoprophylaxis regimen for trans-sphenoidal surgery is effective at preventing perioperative meningitis in patients who do not require lumbar drainage after surgery. The results of this regimen compare favorably to historical rates achieved with longer regimens that use two antibiotics. Future studies will investigate the role prophylactic antibiotics play in nasal mucosa healing and sinusitis.     

Perioperative antibiotic prophylaxis in general thoracic surgery.

A prospective study of the efficacy of ampicillin in combination with sulbactam, a beta-lactamase inhibitor, (A/S) in perioperative prophylaxis was performed. The study consisted of two independent parts performed at the same time. Part I included 60 patients with lobectomies and segmentectomies. Group A (A/S 1 x 3 g "single shot") was compared with group B (A/S 3 x 3 g). Superficial wound infections occurred in 3 patients of group A and in 2 patients of group B. There was no empyema. Bronchitis and pneumonia were found in 10 patients of group A and in 7 patients of group B. Part II examined 25 pneumonectomies receiving A/S 3 x 3 g for 3 days. Concentrations of ampicillin and sulbactam in serum and lung tissue were determined and showed adequate levels to cope with usual bacteria in lung surgery. There was one superficial wound infection, 2 cases of bronchitis, and 2 cases of pneumonia.     

A critical review of antibiotic prophylaxis in orthopedic surgery

A review of controlled clinical trials of antibiotic prophylaxis in orthopedic surgery is presented. Two well-designed and well-conducted studies support the efficacy of prophylactic antibiotics for prevention of wound infection in surgery of hip fractures. Several studies support a role for prophylactic antibiotics in total hip replacement, but it should be noted that equally low rates of wound infection have been attained in hypersterile operating theaters without any prophylactic antibiotics. The role of antibiotic-containing cement in total hip replacement surgery needs further critical evaluation.     

不中断冠脉循环下心内直视术的临床研究

目的总结不中断心脏冠脉循环下心内直视术的体会。方法2001年10月至2007年12月在不中断心脏冠状循环下施行各种心内直视术235例，其中心肌顺行灌注162例、逆行灌注73例；81例在心室颤动下完成手术，其余患者在心脏跳动中完成手术。结果全组死亡4例（1．70％），心脏跳动中和心室颤动下手术结果差异无统计学意义。结论只要在术中保持持续、有效的心肌有氧灌注，无论在心脏跳动中或心室颤动下手术均可取得良好效果。