伴感染危险因素的心脏直视手术围术期预防性抗生素研究——第三、四代头孢菌素的疗效对比

Antibiotic Prophylaxis in Cardiac Surgery with High Infectious Risk: Comparison of Third-and Fourth-Generation Cephalosporins

目的 :对比围手术期应用头孢曲松 (CFT)和头孢吡肟 (CFP)在伴感染危险因素的心脏直视手术中 ,预防各种感染的效果。方法 :2 0 0 2年 5月～ 2 0 0 3年 6月伴有 1项以上感染危险因素的成年心脏直视手术患者 ,随机分为两组 ,围手术期分别给予头孢曲松和头孢吡肟预防感染 ,疗程 6d。观察各种感染情况 ,包括肺部、胃肠道、尿道、手术伤口、血液等感染。比较两组感染发生率和细菌学检查结果。结果 :2 12例患者中 ,CFT组 10 3例 ,感染 13例 (12 .6 % ) ,包括肺部感染 9例 ,肠道感染 3例 ,胆囊炎 1例 ;CFP组 10 9例 ,感染 14例 (12 .8% ) ,肺部感染 7例 ,肠道感染 5例 ,腮腺炎 1例 ,牙周脓肿 1例 ,两组感染发生率无显著差异 (P >0 .0 5 )。细菌学检查中两组均分离到耐药葡萄球菌和真菌。结论 :在有感染危险因素的心脏直视手术后患者中 ,围手术期第三代头孢菌素 (CFT)和第四代头孢菌素 (CFP)

Objective: The perioperative antibiotic prophylaxis of cefetriaxone and cefepime are evaluated in patients undergoing open heart surgery with infectious risk factor. Methods: Between May 2002 and June 2003, adult patients undergoing open heart surgery with at least 1 infectious risk were enrolled. They were randomized to cefetriaxone(CFT) and cefepime(CFP) group, and received perioperative CFT and CFP prophylaxis respectively for 6 days. The postoperative nosocomial infection rate was compared between the two groups. Bacteriologic exam was performed if necessary. Results: 212 patients were enrolled. The infection rate was 12.6%(13/103) in CFT group( 9 case of pnueumonia, 3 case of coloenteritis, 1 case of cholecystitis), 12.8%(14/109) in CFP group(7 case of pnueumonia, 5 case of coloenteritis, 1 parotitis, 1 periodontal abscess).There is no difference between the two groups (P>0.05). Methicillin-resistant staphylococcus and fungus was isolated in sputum and stool of patients in both group. Conclusion:The third- and fourth- cephalosporins has the similar perioperative antibiotic effect in the open heart surgery patients with infectious risk factor.