Selecting cost-effective antimicrobial prophylaxis in surgery: are we getting what we pay for?

The acquisition, administration, and infection-related expenses associated with the use of cefazolin or cefamandole during a prospective randomized comparison of antimicrobial prophylaxis in cardiac surgery were compared. Although the acquisition cost and administration charges related to the use of cefamandole were in excess of those incurred with cefazolin, differences in the charges associated with treating the wound infections that failed prophylaxis with each regimen made cefamandole the more cost-effective prophylactic agent (mean total of $766 per cefazolin recipient vs. $315 per cefamandole recipient).

Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest.

Purpose: Recent reports on the use of in-hospital cardiopulmonary resuscitation (CPR) have failed to provide an applicable method to identify patients who have little chance of surviving CPR. We prospectively evaluated the clinical characteristics and outcome of 140 consecutive hospitalized patients who had cardiopulmonary arrest and received CPR, and we propose a method for predicting survival in this setting.

Patients And Methods: The study period was July 1 through December 31, 1985, and the patient population consisted of 91 men and 49 women (age range, 18 to 92 years).

Immunogenicity of the intradermal route of hepatitis B vaccination with the use of recombinant hepatitis B vaccine.

In March 1987, 32 hospital employees were enrolled in a prospective trial of intradermal recombinant hepatitis B vaccination. Enrollees were given 0.1 ml of vaccine on days 1, 30, and 180.

Bronchopulmonary cross-colonization and infection related to mycobacterial contamination of suction valves of bronchoscopes.

Recurrent episodes of mycobacterial cross-contamination of bronchoscopy specimens were identified in a large, tertiary-care referral center. One episode was followed by active pulmonary infection due to Mycobacterium tuberculosis. Initial epidemiologic investigation implicated the flexible fiberoptic bronchoscopes.

Overview of cephalosporin prophylaxis.

After an uncertain and highly controversial beginning, the use of antimicrobials for prophylaxis of surgical wound infection has evolved to represent state-of-the-art management of the surgical patient. Although a truly ideal prophylactic antimicrobial does not exist, the cephalosporins, particularly those of the first generation, have emerged as the mainstay of prophylaxis in surgery. However, new pathogens and newly recognized problems have necessitated a comparative evaluation of a wide variety of antibiotic regimens.

Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis.

By use of techniques that have been developed to detect small numbers of methicillin-resistant staphylococci, we cultured samples from the nares and subclavian and inguinal areas of 29 patients before and after cardiac surgery and 10 patients before and after coronary angioplasty. Methicillin-resistant coagulase-negative staphylococci were recovered before the surgical or angioplasty procedure from 74% of patients. The quantitative recovery of methicillin-resistant isolates before cardiac surgery or coronary angioplasty was compared with the number of methicillin-resistant staphylococci detected at the same site 3 days after the procedure.

Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers.

We undertook a prospective randomized observer-blinded study comparing the ability of preoperative showers with chlorhexidine gluconate (Hibiclens), povidone-iodine (Betadine), and a lotion soap (Safe 'N Sure) to diminish the staphylococcal skin flora of patients. By block randomization, patients scheduled for an elective cardiac operation or coronary artery angioplasty were assigned to shower with one of the study skin cleansers either once (evening only) or twice (both evening and morning) before the procedure. Semiquantitative samples for culture were obtained from the subclavian and inguinal sites on the evening before the procedure (baseline culture) and again the next morning before the operation.

Efficacy of cefazolin, cefamandole, and gentamicin as prophylactic agents in cardiac surgery. Results of a prospective, randomized, double-blind trial in 1030 patients.

In an effort to develop an improved regimen of antibiotic prophylaxis in cardiac surgery, 1030 patients who were to have elective cardiothoracic surgery involving a median sternotomy were selected at random to receive cefamandole or cefazolin, with or without gentamicin, in a prospective double-blind study. Cefazolin was significantly less effective than cefamandole at both the sternal (1.8% vs.