Whether 3.0 gram cefuroxime versus 1.5 gram cefuroxime prophylaxis before cardiac surgeries diminishes postoperative pneumonia and fever: a nested case-control study

Abstract

Whether 3.0 g cefuroxime (CXM) prophylaxis before cardiac surgeries effectively avoided postoperative pneumonia (POP) and fever (POF) compared with 1.5 g is debatable, which needed to be confirmed by evidence-base medicine. A total of 301 patients who underwent CXM perioperative prophylaxis before cardiac surgeries from Jan 2023 to Dec 2023 at the First Affiliated Hospital of Nanjing Medical University were incorporated in a nested case-control study. The patients were divided into the 1.5 g ( n = 170) and 3.0 g ( n = 131) groups according to the first dosage of prophylactic CXM. Outcomes included POP and POF. Risk and stratification analysis was performed for the effect and modification of different dosages of CXM on outcomes. The risk of POF in 3.0 g group (67, 51.15%) was higher than 1.5 g group (52, 30.59%) unadjusted (OR = 2.38, 95% CI :1.48 ~ 3.81, P < 0.001) or adjusted (OR = 2.38, 95% CI :1.36 ~ 4.14, P = 0.002) for the confounding variables. There was no significant difference in POP between the two groups unadjusted (OR = 1.26, 95% CI :0.62 ~ 2.55, P = 0.522) or adjusted (OR = 1.03., 95% CI :0.48 ~ 2.20, P = 0.945) for the confounding variables. The results of stratification analysis showed two different dosages of CXM didn’t generate modification on the other risk factors of POF. 3.0 g CXM prophylaxis before cardiac surgeries didn’t decrease the incidence of POP but increased the risk of POF compared with 1.5 g. However, limited by underpowered sample size and the overly broad research population, the conclusions needed to be validated by a prospective cohort study.