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To investigate risk factors of postoperative infection following cardiac surgery, we conducted a retrospective analysis of two surgical procedures, off-pump primary coronary artery bypass grafting (off-pump CABG: OPCAB) and surgery for valvular heart disease (valve operation). A total of 524 consecutive patients undergoing primary OPCAB and 262 consecutive patients undergoing a primary valve operation, between January 2001 and December 2002, were studied. We divided the patients into two groups: those treated with cefazolin (CEZ) both before and after surgery (CEZ-not-replaced group) and those in whom CEZ was replaced by other antibiotics after surgery (CEZ-replaced group) and conducted our analysis in consideration of patient-related factors and surgical procedure-related factors. After discussing the analysis results with the respective physicians, the dosing guidelines for CEZ were changed as follows: 1) Shorten postoperative administration of CEZ to two days, 2) Switch to alternative antibiotics if outcome of WBC on postoperative day 3 indicates such necessity, and 3) Additionally administer intra-operative CEZ when surgery exceeds four hours. We also analyzed the rate of CEZ replacement with other antibiotics after surgery finding that it decreased in both groups for OPCAB and valve operations. From these results, we conclude that, if CEZ is also administered intra-operatively when surgery is prolonged, its administration for two days following surgery is adequate for prophylaxis against postoperative infection.

iryō yakugaku/iryou yakugaku

Optimal Use of Cefazolin, a Prophylactic Antibiotic, for the Prevention of Infection Following Cardiac Surgery (Part 2)-Additional Administration of Intraoperative Cefazolin when Surgery is Prolonged Allows its Postoperative Administration to be Shortened