Comparison between cefotaxime and a combination of benzylpenicillin and cloxacillin as an antibiotic prophylaxis in cardiac surgery with cardio-pulmonary bypass.

In a prospective randomized trial, 422 patients undergoing elective cardiac surgery with cardiopulmonary bypass were studied for comparing two types of prophylactic antibiotic treatment. One group, 204 patients, received 4 doses of cefotaxime for 2 days. The other group, 198 patients, received 6 doses of benzylpenicillin combined with cloxacillin for 3 days. Sixty percent received the planned cefotaxime prophylaxis (CTX), while 43.4% received the planned combined benzylpenicillin with cloxacillin prophylaxis (BPC). This was because several patients in both groups required additional antibiotics for treatment of high fever (39.7%, CTX-ADD, in the cefotaxime group compared to 56.6%, BPC-ADD in the other group (p less than 0.01). The overall infection rate in the groups receiving the planned prophylaxis was significantly lower (4.1%) in the CTX-group compared to the 14% in the BPC-group (p less than 0.05). Early infections (less than 14 days) were lower in the groups CTX-group (3%) compared to the BPC-group (16%) (p less than 0.046). In the groups receiving additional antibiotics for fever (CTX-ADD and BPC-ADD), the former had a significantly lower number of infections, 16 compared to 23, in the latter group (p less than 0.01). There were significantly fewer early infections in the CTX-ADD compared to the BPC-ADD group (4 vs. 10 respectively, p less than 0.01). No deep infections were seen when CTX or CTX-ADD was used, while 6 deep wound infections occurred when BPC or BPC-ADD was used. The lowest rate of positive cultures of bacteria was seen in the CTX-group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)