Antibiotic Prophylaxis in Vascular Surgery

Preoperative and intraoperative antibiotic prophylaxis of infection in peripheral vascular surgery has been widely used although controlled studies have been lacking. A randomized, prospective, double-blind study of cefazolin versus placebo during 565 arterial reconstructive operations was performed at this hospital from February 1976 through August 1977. Among the 462 patients undergoing surgery of the abdominal aorta and lower extremity vasculature, there was a highly significant difference in the infection rates: 6.8% for placebo recipients versus 0.9% for cefazolin recipients (p <.001). Of the 18 infections, four involved vascular grafts and all four graft infections occurred in the placebo group. Over 8% of abdominal wounds of patients receiving placebo became infected versus 1.2% of cefazolin patients (p <.05). Groin wounds were infected infrequently, 1.1% for placebo patients versus none for cefazolin patients. No infections occurred among 103 brachiocephalic procedures. Skin antisepsis was analyzed retrospectively. Infection rates were significantly higher (p <.01) following hexachlorophene-ethanol versus a povidone-iodine skin preparation. Adverse effects of cefazolin were carefully monitored: no rash, phlebitis, or emergence of resistant strains was observed. A brief perioperative course of cefazolin and povidone-iodine skin antisepsis are recommended in vascular reconstructive surgery of the abdominal aorta and lower extremity vasculature.

[1]  Roberts Nj,et al.  Gentamicin Use and Pseudomonas and Serratia Resistance: Effect of a Surgical Prophylaxis Regimen , 1978 .

[2]  T. K. Hunt,et al.  Antibiotics in surgery. , 1975, Archives of surgery.

[3]  G. Ayliffe,et al.  Preoperative Disinfection of Surgeons' Hands: Use of Alcoholic Solutions and Effects of Gloves on Skin Flora , 1974, British medical journal.

[4]  J. Waldhausen,et al.  Infection of arterial prostheses. , 1974, Surgery, gynecology & obstetrics.

[5]  W. Moore,et al.  Infection in vascular prostheses. Clinical manifestations and surgical management. , 1974, American journal of surgery.

[6]  P. Stolley,et al.  This is medical progress? Trends and consequences of antibiotic use in the United States. , 1974, JAMA.

[7]  D. Pohlod,et al.  Clinical Studies of Cefazolin and Comparison with Other Cephalosporins , 1973, Antimicrobial Agents and Chemotherapy.

[8]  A. Pollock,et al.  The reduction of surgical wound infections by prophylactic parenteral cephaloridine a controlled clinical trial , 1973, The British journal of surgery.

[9]  A. Duncan,et al.  The comparative effectiveness of iodophor and hexachlorophene surgical scrub solutions. , 1972, Surgery, gynecology & obstetrics.

[10]  J. P. Elliott,et al.  Infection in Arterial Reconstruction with Synthetic Grafts , 1972, Annals of surgery.

[11]  W. Baker,et al.  The administration of antibiotics in vascular reconstructive surgery. A comparison of the effectiveness of systemic cephaloridine versus cephaloridine-soaked grafts in preventing graft infections in dogs. , 1972, The Journal of thoracic and cardiovascular surgery.

[12]  R. Elashoff,et al.  Antibiotic prophylaxis and cardiac surgery. A prospective double-blind comparison of single-dose versus multiple-dose regimens. , 1972, Annals of internal medicine.

[13]  A. D. Hall,et al.  Effect of prophylactic antibiotics in preventing bacteremic infection of vascular prostheses. , 1971, Surgery.

[14]  P. Hoffert,et al.  INFECTION COMPLICATING ARTERIAL GRAFTS: PERSONAL EXPERIENCE WITH 12 CASES AND REVIEW OF THE LITERATURE. , 1965, Archives of surgery.

[15]  M. Smith,et al.  PREOPERATIVE SKIN PREPARATION WITH POVIDONE-IODINE. , 1964, American journal of surgery.

[16]  J. Burke.  The effective period of preventive antibiotic action in experimental incisions and dermal lesions. , 1961, Surgery.

[17]  J. Christenson,et al.  Synthetic arterial grafts. II. infection complications. , 1977, Scandinavian journal of thoracic and cardiovascular surgery.