Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.8.5 Alternatives to intravenous antibiotics.
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Desmond
2003
[37]
United
Kingdom
Cohort
study
14 pts with elective
arterial surgery were
prospectively studied.
One surgeon. Study
absorption and systemic
levels of vancomycin.
Serum samples at
30, 60 120, 180
and 730 min in 7 pts
and at 60 and 180 min,
7 pts. In 4 pts samples
from chest drains.
10 pts urinary samples
Iv prophylaxis according to
routine (type not stated). At
closure of sternotomy pts
were randomised to
I1: 500 mg vancomycin powder
I2: 500 mg vancomycin powder
dissolved in 10 mL saline
Serum samples
No difference
between groups
in serum or urinary
levels. Peak serum
levels at 30 min
(mean 2.96 mg/l;
0.99–5.00). At 6 h
1.32 mg/l (0.56–2.17)
T1/2 5 h. Chest drain
levels: 11.3 mg/l
(0.52–29.4)
Moderate
Significant systemic
levels of vancomycin
and in urine for
5 days. Recommended
systemic concentration:
5–10 mg/l.
Small patient study.
Local therapy exposes
patients to systemic
and urinary vancomycin
in significant
doses, but the
exposure below dose
required to inhibit
Staphylococcus aureus
Eklund
2005
[38]
Finland
RCT
557 pts undergoing
elective CABG
during 1 year. Sealed
envelopes. SSI defined.
Follow-up 3 months
I: 10 cm x 10 cm gentamicin
– collagen implant (130 mg gentamicin
and 280 mg collagen)
before wound closure. 2 doses
iv cefuroxime 1.5 g 0 and 6 h.
In addition iv vancomycin
500 mg on two occasions
if hospital stay >72 h
C: No implant 2 doses
iv cefuroxime 1.5 g
and 0 and 6 h in
addition iv vancomycin
500 mg on two
occations if hospital
stay >72 h
Sternal wound infection
I: 11/272 (4.0%)
C: 16/270 (5.9%)
p=0.201
Mediastinitis
I: 3/272 (1.1%)
C: 5/270 (1.9%)
p=0.470
20 pts did
not meet
inclusion
criteria
5 refused to
participate
4 deceased
Moderate
No difference.
Slightly better results
in intervention group.
No side effects. Safe
therapy
Gram positive organisms
accounted for
most infections
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