A Double-blind Comparative Study of Prophylactic Antibiotic Therapy in Open Heart Surgery: Penicillin G versus Vancomycin

Summary

A double-blind clinical study was carried out comparing the prophylactic effectivity of penicillin G with vancomycin in 113 adult patients undergoing open heart surgery. Eighty of these underwent valve replacement. A total of 14 of 52 penicillin-treated patients (26.9%) and 5 of 61 vancomycintreated patients (8.2 %) suffered from postoperative infection (0.005<p<0.02). Five patients in the penicillin group and none in the vancomycin group developed postoperative wound infection (0.01<p<0.02). No significant differences in blood culture and sepsis, tracheal culture and clinical respiratory tract infection, urine culture and clinical urinary tract infection, and colonization rate were found between the 2 groups. No cases of prosthetic valve endocarditis were diagnosed. Bacteriologic culture and resistance studies did not reveal significant changes concerning the resistance patterns; in particular, the emergence of a vancomycin-resistant strain of Staphylococcus albus was not seen. A decrease in the colonization rate with Staphylococcus albus from 53% in 1975 to 1977 to 34.6% and 31.1 % in the penicillin and vancomycin groups, respectively, was found in the following 2 years.

Key words

Open heart surgery - Prophylaxis - Penicillin G - Vancomycin