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J Thorac Cardiovasc Surg 2000;120:1120-1130
© 2000 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Comparative efficacy of teicoplanin and cefazolin for cardiac operation prophylaxis in 3027 patients

From the Department of Medicine, The University of Ottawa, Ottawa,^a Infectious Diseases Research Center, Université Laval, Québec City,^c and Aeterna Laboratory, Québec City,^b Canada.

Supported by Hoechst Marion Roussel Canada Research Inc.

Presented in part at the 19th International Congress of Chemotherapy, Montreal, July 16-21, 1995.

Address for reprints: Michel G. Bergeron, MD, FRCPC, Centre de Recherche en Infectiologie, Université Laval, CHUQ, Pavillon CHUL, 2705 Boul Laurier, Québec, QC G1V 4G2 Canada (E-mail: Michel.G.Bergeron{at}crchul.ulaval.ca).

Objective: Cephalosporins, especially cefazolin, are widely used in the prevention of postoperative wound infections after cardiac operations. As more and more Staphylococcus aureus and Staphylococcus epidermidis strains are becoming resistant to cephalosporins and other antibiotics, alternative agents, such as glycopeptides, are often used as prophylaxis. We performed a multicenter double-blind randomized controlled trial comparing teicoplanin, a glycopeptide antibiotic, with cefazolin.
Methods: A total of 3027 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both were randomized to a single dose of teicoplanin (15 mg/kg) or a 2-day course of cefazolin (2 g initial dose, followed by 1 g every 8 hours for 6 more doses). Patients were followed up for a total of 6 months postoperatively. The primary objective was to compare, between groups, the incidence of surgical infections up to 30 days postoperatively. Secondary objectives were incidence of other infections, other complications, and death.
Results: A total of 3027 patients were randomized to receive either teicoplanin (n = 1518) or cefazolin (n = 1509). Thirty days postoperatively, there was a trend to more deep sternotomy wound infections in the teicoplanin group (31 vs 18, P = .087), which became significant by 6 months (36 vs 19, P = .032). One hundred percent of the gram-positive strains infecting patients were susceptible to teicoplanin, whereas 8.3% were resistant to cefazolin. Pneumonia and urinary tract infections were more common in the teicoplanin group. Deep wound infections of the leg were more common in the cefazolin group.
Conclusions: Cefazolin was more effective prophylaxis than teicoplanin against postoperative wound infections after elective cardiac operations. Infection rates were low with either treatment.

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