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J Thorac Cardiovasc Surg 1994;107:896-900
© 1994 Mosby, Inc.

GENERAL THORACIC SURGERY

Antibiotic prophylaxis in pulmonary surgeryA prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime

Dijon, France

Received for publication Feb. 1, 1993. Accepted for publication Aug. 2, 1993. Address for reprints: A. Bernard, MD, Clinique Chirurgicale, Hôpital du Bocage, 21034 Dijon-Cedex, France.

Abstract

The aim of this study was to determine whether a 48-hour antibiotic prophylaxis regimen with a second-generation cephalosporin was more efficient than a flash antibiotic prophylaxis regimen in pulmonary operations. All the included patients underwent lung resection. Patients with preoperative infection were excluded. All the patients were given cefuroxime (1.5 gm intravenously) at the time of the anesthesic induction and again 2 hours later. The randomization was done postoperatively: group 1 was given placebo intravenously (n = 102) and group 2 was given cefuroxime intravenously (n = 101), each every 6 hours for 48 hours. The overall rate of infections was 46% in the 48-hour cefuroxime group versus 65% in the flash group (p = 0.005). The difference remained significant even after an adjustment with prognosis variables (p = 0.01). Six empyemas (6%) in the flash group were noted versus one (1%) in the 48-hour group (p = 0.03). From day 3 to day 8 after the operation, chest x-ray films were more often assessed as being normal in the flash group than in the 48-hour group (p = 0.005). On day 3 after operation, white blood cell counts were 13,020 ± 1,220 elements/mm³in the flash group versus 11,620 ± 1,220 elements/mm³in the 48-hour group (p = 0.03). A 48-hour antibiotic prophylaxis regimen decreases the rate of deep infections and particularly the rate of empyemas. (J THORACCARDIOVASCSURG1994;107:896-900)

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