Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery

Details

Serval ID
serval:BIB_4A1F78F6CDE0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery
Journal
Emerging Infectious Diseases
Author(s)
Zanetti  G., Goldie  S. J., Platt  R.
ISSN
1080-6040
Publication state
Published
Issued date
10/2001
Peer-reviewed
Oui
Volume
7
Number
5
Pages
820-7
Notes
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. --- Old month value: Sep-Oct
Abstract
Routine us of vancomycin for perioperative prophylaxis is discouraged, principally to minimize microbial resistance to it. However, outcomes and costs of this recommendation have not been assessed. We used decision-analytic models to compare clinical results and cost-effectiveness of no prophylaxis, cefazolin, and vancomycin, in coronary artery bypass graft surgery. In the base case, vancomycin resulted in 7% fewer surgical site infections and 1% lower all-cause mortality and saved $117 per procedure, compared with cefazolin. Cefazolin, in turn, resulted in substantially fewer infections and deaths and lower costs than no prophylaxis. We conclude that perioperative antibiotic prophylaxis with vancomycin is usually more effective and less expensive than cefazolin. Data on vancomycin's impact on resistance are needed to quantify the trade-off between individual patients' improved clinical outcomes and lower costs and the future long-term consequences to society.
Keywords
Aged Anti-Bacterial Agents/economics/*therapeutic use *Antibiotic Prophylaxis/economics Cefazolin/therapeutic use Cephalosporins/therapeutic use Coronary Artery Bypass/*adverse effects Cost-Benefit Analysis Humans Male Methicillin Resistance Staphylococcal Infections/economics/epidemiology/microbiology/prevention & control Staphylococcus aureus/drug effects Surgical Wound Infection/economics/epidemiology/*prevention & control Vancomycin/economics/pharmacology/*therapeutic use Vancomycin Resistance
Pubmed
Web of science
Create date
21/01/2008 10:04
Last modification date
20/08/2019 13:57
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