human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The efficiency of a single two gram bolus of Ceftriaxone for cardiac operations was evaluated versus a classical , multiple dose , antibiotic prophylaxis using Cefam and ole . The results were quite similar in both groups , with a very low infection rate . We conclude that a single bolus prophylaxis using a broad spectrum antibiotic is as efficient as an ordinary , multiple dose technique BACKGROUND Despite evidence supporting short antibiotic prophylaxis ( ABP ) , it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft ( CABG ) surgery . METHODS AND RESULTS To compare the effect of short ( < 48 hours ) versus prolonged ( > 48 hours ) ABP on surgical site infections ( SSIs ) and acquired antimicrobial resistance , we conducted an observational 4-year cohort study at a tertiary-care center . An experienced infection control nurse performed prospect i ve surveillance of 2641 patients undergoing CABG surgery . The main exposure was the duration of  ABP  , and main outcomes were the adjusted rate of SSI and the isolation of cephalosporin-resistant enterobacteriaceae and vancomycin-resistant enterococci ( acquired antibiotic resistance ) . Adjustment for confounding was performed by multivariable modeling . A total of 231 SSIs ( 8.7 % ) occurred after a median of 16 days , including 93 chest-wound infections ( 3.5 % ) and 13 deep-organ-space infections ( 0 . 5 % ) . After 1502 procedures using short ABP , 131 SSIs were recorded , compared with 100 SSIs after 1139 operations with prolonged ABP ( crude OR , 1.0 ; CI , 0.8 to 1.3 ) . After adjustment for possible confounding , prolonged ABP was not associated with a decreased risk of SSI ( adjusted OR , 1.2 ; CI , 0.8 to 1.6 ) and was correlated with an increased risk of acquired antibiotic resistance ( adjusted OR , 1.6 ; CI , 1.1 to 2.6 ) . CONCLUSIONS Our findings confirm that continuing ABP beyond 48 hours after CABG surgery is still widespread ; however , this practice is ineffective in reducing SSI , increases antimicrobial resistance , and should therefore be avoided The efficacy of antibiotic prophylaxis in cardiac surgery was compared between 97 patients receiving a single 2 g dosage of ceftriaxone and 103 receiving 500 mg of vancomycin i.v . every 6 h for 48 h. The overall infection rate was 13.4 % in the ceftriaxone and 10.7 % in the vancomycin group . Four ( 4 % ) wound infections , including one mediastinitis , occurred in the ceftriaxone group and five ( 5 % ) in the vancomycin group , with no statistically significant difference . The findings of this study support the adequacy of a simple single dose of ceftriaxone prophylaxis in cardiac surgery , at least in hospitals with low incidence of vancomycin-resistant staphylococcal infections In a prospect i ve study of cephalothin prophylaxis for patients who underwent aortocoronary bypass an unacceptably high rate ( 44 % ) of Staphylococcus aureus sternotomy infections occurred in a placebo-treated group . In two other groups of patients , one group given cephalothin intraoperatively and the other given the antibiotic both intra- and postoperatively , such infections occurred with similar frequency ( 2.6 % and 2.1 % respectively ) . This study demonstrates the need for  antistaphylococcal agents  during aortocoronary bypass operation . No advantage is derived by extending this therapy beyond the operative period HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54.8%-56.6 % ) of patients within 1 hour before incision .  Antimicrobial agents consistent with published guidelines were administered to 92.6 % ( 95 % CI , 92.3%-92.8 % ) of the patients .  Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7 % ( 95 % CI , 40.2%-41.2 % ) of patients . CONCLUSION Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery One hundred four patients undergoing elective open heart surgery were enrolled in a prospect i ve , double-blind trial comparing prophylaxis against infection using a single 1 g dose of ceftriaxone and seven doses of cefazolin . Patients in both groups had similar risk factors for infection . The likelihood of achieving a tissue concentration in excess of the minimal inhibitory concentration for Staph . aureus was significantly greater with ceftriaxone in atrial appendage ( p less than 0.001 ) , muscle ( p less than 0.01 ) , and bone ( p less than 0.01 ) than with cefazolin . The serum half-life of ceftriaxone was approximately 15.7 hours . All 49 serum sample s obtained 18 to 24 hours after delivery of ceftriaxone and 26 of 33 sample s obtained 40 to 48 hours after delivery had drug concentrations in excess of 3.1 micrograms/ml , the mean minimal inhibitory concentration for isolates of Staph . aureus . Early and late infectious complications were infrequent and occurred at similar rates in both groups . Neither drug was associated with significant toxicity . A single 1 g dose of ceftriaxone was as effective and safe as multiple doses of cefazolin and demonstrated superior tissue penetration OBJECTIVE Cephalosporins , especially cefazolin , are widely used in the prevention of postoperative wound infections after cardiac operations . As more and more Staphylococcus aureus and Staphylococcus epidermidis strains are becoming resistant to cephalosporins and other antibiotics , alternative agents , such as glycopeptides , are often used as prophylaxis . We performed a multicenter double-blind r and omized controlled trial comparing teicoplanin , a glycopeptide antibiotic , with cefazolin . METHODS A total of 3027 adult patients undergoing elective coronary artery bypass grafting , valve operations , or both were r and omized to a single dose of teicoplanin ( 15 mg/kg ) or a 2-day course of cefazolin ( 2 g initial dose , followed by 1 g every 8 hours for 6 more doses ) . Patients were followed up for a total of 6 months postoperatively . The primary objective was to compare , between groups , the incidence of surgical infections up to 30 days postoperatively . Secondary objectives were incidence of other infections , other complications , and death . RESULTS A total of 3027 patients were r and omized to receive either teicoplanin ( n = 1518 ) or cefazolin ( n = 1509 ) . Thirty days postoperatively , there was a trend to more deep sternotomy wound infections in the teicoplanin group ( 31 vs 18 , P = . 087 ) , which became significant by 6 months ( 36 vs 19 , P = .032 ) . One hundred percent of the gram-positive strains infecting patients were susceptible to teicoplanin , whereas 8.3 % were resistant to cefazolin . Pneumonia and urinary tract infections were more common in the teicoplanin group . Deep wound infections of the leg were more common in the cefazolin group . CONCLUSIONS Cefazolin was more effective prophylaxis than teicoplanin against postoperative wound infections after elective cardiac operations . Infection rates were low with either treatment To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting , 1,016 consecutive patients were prospect ively r and omized to receive either a single dose or a three-day course of cefuroxime . Nine patients ( 0.9 % ) died within seven days ; no death was caused by infection . For various reasons 163 other patients were not evaluable . Therefore , 844 patients were evaluated . Patients in group A ( n=419 ) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia ; group B ( n=425 ) received the same dose followed by 750 mg t.i.d . for three consecutive days . Both groups were comparable regarding all risk factors . The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups . No significant differences in wound infection were observed between the two treatment groups : sternal site infection in the single-dose prophylaxis group was 14 % versus 13 % in the three-day course group ; donor site infection occurred in 38 % versus 39 % . It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection Objective To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for  surgical-site infections and remote infections such as respiratory tract infections ( RTIs ) and urinary tract infections ( UTIs ) . Methods The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local ( surgical wound ) and remote ( RTIs and UTIs ) infections  in a meta- analysis of r and omised controlled trials published between 1984 and 2003 . The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies . Results Evaluations were performed on 48 studies , for a total of 17 565 patients . Overall , 406 patients ( 4.8 % ) in the ceftriaxone group and 525 ( 6.3 % ) in the comparator group developed a surgical-site infection ( log odds ratio [ OR ] −0.30 [ CI −0.50 to −0.13 ] ; p < 0.0001 ) . RTIs were observed in 292 ( 6.01 % ) patients in the ceftriaxone group and in 369 ( 7.6 % ) patients in the comparator group , ( log OR −0.30 [ CI −0.55 to −0.09 ] ; p = 0.0013 ) . UTIs were reported for 2.2 % of the ceftriaxone prophylaxis patients compared with 3.74 % of the comparator group patients ( log OR −0.54 [ CI −1.18 to −0.16 ] ; p < 0.0001 ) . Overall , in clean surgery 195 ( 5.1 % ) and 234 ( 6.2 % ) patients developed a surgical site infection in the ceftriaxone and comparator groups , respectively ( log OR −0.22 [ CI −0.51 to 0.01 ] ; p = 0.0476 ) . RTIs were prevented for all but 1.57 % of patients in the ceftriaxone group and 2.62 % of patients in the comparator group ( p = 0.01 ) in clean surgery , and for 9.54 % of the ceftriaxone group versus 11.6 % of the comparator group ( p = 0.01 ) in clean-contaminated surgery . While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence ( log OR −0.21 [ CI 0.0–0.65 ] ; p = 0.7702 ) , this was clearly shown in the clean-contaminated surgery . In fact , 4.47 % of patients in the ceftriaxone group versus 7.52 % of patients in the comparator group developed a 
    Output:
    
agent
There were no statistically significant differences in mortality , infections overall and adverse events .
Perioperative antibiotic prophylaxis of ≥24 hours may be more efficacious in preventing sternal SSIs in patients undergoing cardiac surgery compared to shorter regimens .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The efficiency of a single two gram bolus of Ceftriaxone for cardiac operations was evaluated versus a classical , multiple dose , antibiotic prophylaxis using Cefam and ole . The results were quite similar in both groups , with a very low infection rate . We conclude that a single bolus prophylaxis using a broad spectrum antibiotic is as efficient as an ordinary , multiple dose technique BACKGROUND Despite evidence supporting short antibiotic prophylaxis ( ABP ) , it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft ( CABG ) surgery . METHODS AND RESULTS To compare the effect of short ( < 48 hours ) versus prolonged ( > 48 hours ) ABP on surgical site infections ( SSIs ) and acquired antimicrobial resistance , we conducted an observational 4-year cohort study at a tertiary-care center . An experienced infection control nurse performed prospect i ve surveillance of 2641 patients undergoing CABG surgery . The main exposure was the duration of  ABP  , and main outcomes were the adjusted rate of SSI and the isolation of cephalosporin-resistant enterobacteriaceae and vancomycin-resistant enterococci ( acquired antibiotic resistance ) . Adjustment for confounding was performed by multivariable modeling . A total of 231 SSIs ( 8.7 % ) occurred after a median of 16 days , including 93 chest-wound infections ( 3.5 % ) and 13 deep-organ-space infections ( 0 . 5 % ) . After 1502 procedures using short ABP , 131 SSIs were recorded , compared with 100 SSIs after 1139 operations with prolonged ABP ( crude OR , 1.0 ; CI , 0.8 to 1.3 ) . After adjustment for possible confounding , prolonged ABP was not associated with a decreased risk of SSI ( adjusted OR , 1.2 ; CI , 0.8 to 1.6 ) and was correlated with an increased risk of acquired antibiotic resistance ( adjusted OR , 1.6 ; CI , 1.1 to 2.6 ) . CONCLUSIONS Our findings confirm that continuing ABP beyond 48 hours after CABG surgery is still widespread ; however , this practice is ineffective in reducing SSI , increases antimicrobial resistance , and should therefore be avoided The efficacy of antibiotic prophylaxis in cardiac surgery was compared between 97 patients receiving a single 2 g dosage of ceftriaxone and 103 receiving 500 mg of vancomycin i.v . every 6 h for 48 h. The overall infection rate was 13.4 % in the ceftriaxone and 10.7 % in the vancomycin group . Four ( 4 % ) wound infections , including one mediastinitis , occurred in the ceftriaxone group and five ( 5 % ) in the vancomycin group , with no statistically significant difference . The findings of this study support the adequacy of a simple single dose of ceftriaxone prophylaxis in cardiac surgery , at least in hospitals with low incidence of vancomycin-resistant staphylococcal infections In a prospect i ve study of cephalothin prophylaxis for patients who underwent aortocoronary bypass an unacceptably high rate ( 44 % ) of Staphylococcus aureus sternotomy infections occurred in a placebo-treated group . In two other groups of patients , one group given cephalothin intraoperatively and the other given the antibiotic both intra- and postoperatively , such infections occurred with similar frequency ( 2.6 % and 2.1 % respectively ) . This study demonstrates the need for  antistaphylococcal agents  during aortocoronary bypass operation . No advantage is derived by extending this therapy beyond the operative period HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54.8%-56.6 % ) of patients within 1 hour before incision .  Antimicrobial agents consistent with published guidelines were administered to 92.6 % ( 95 % CI , 92.3%-92.8 % ) of the patients .  Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7 % ( 95 % CI , 40.2%-41.2 % ) of patients . CONCLUSION Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery One hundred four patients undergoing elective open heart surgery were enrolled in a prospect i ve , double-blind trial comparing prophylaxis against infection using a single 1 g dose of ceftriaxone and seven doses of cefazolin . Patients in both groups had similar risk factors for infection . The likelihood of achieving a tissue concentration in excess of the minimal inhibitory concentration for Staph . aureus was significantly greater with ceftriaxone in atrial appendage ( p less than 0.001 ) , muscle ( p less than 0.01 ) , and bone ( p less than 0.01 ) than with cefazolin . The serum half-life of ceftriaxone was approximately 15.7 hours . All 49 serum sample s obtained 18 to 24 hours after delivery of ceftriaxone and 26 of 33 sample s obtained 40 to 48 hours after delivery had drug concentrations in excess of 3.1 micrograms/ml , the mean minimal inhibitory concentration for isolates of Staph . aureus . Early and late infectious complications were infrequent and occurred at similar rates in both groups . Neither drug was associated with significant toxicity . A single 1 g dose of ceftriaxone was as effective and safe as multiple doses of cefazolin and demonstrated superior tissue penetration OBJECTIVE Cephalosporins , especially cefazolin , are widely used in the prevention of postoperative wound infections after cardiac operations . As more and more Staphylococcus aureus and Staphylococcus epidermidis strains are becoming resistant to cephalosporins and other antibiotics , alternative agents , such as glycopeptides , are often used as prophylaxis . We performed a multicenter double-blind r and omized controlled trial comparing teicoplanin , a glycopeptide antibiotic , with cefazolin . METHODS A total of 3027 adult patients undergoing elective coronary artery bypass grafting , valve operations , or both were r and omized to a single dose of teicoplanin ( 15 mg/kg ) or a 2-day course of cefazolin ( 2 g initial dose , followed by 1 g every 8 hours for 6 more doses ) . Patients were followed up for a total of 6 months postoperatively . The primary objective was to compare , between groups , the incidence of surgical infections up to 30 days postoperatively . Secondary objectives were incidence of other infections , other complications , and death . RESULTS A total of 3027 patients were r and omized to receive either teicoplanin ( n = 1518 ) or cefazolin ( n = 1509 ) . Thirty days postoperatively , there was a trend to more deep sternotomy wound infections in the teicoplanin group ( 31 vs 18 , P = . 087 ) , which became significant by 6 months ( 36 vs 19 , P = .032 ) . One hundred percent of the gram-positive strains infecting patients were susceptible to teicoplanin , whereas 8.3 % were resistant to cefazolin . Pneumonia and urinary tract infections were more common in the teicoplanin group . Deep wound infections of the leg were more common in the cefazolin group . CONCLUSIONS Cefazolin was more effective prophylaxis than teicoplanin against postoperative wound infections after elective cardiac operations . Infection rates were low with either treatment To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting , 1,016 consecutive patients were prospect ively r and omized to receive either a single dose or a three-day course of cefuroxime . Nine patients ( 0.9 % ) died within seven days ; no death was caused by infection . For various reasons 163 other patients were not evaluable . Therefore , 844 patients were evaluated . Patients in group A ( n=419 ) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia ; group B ( n=425 ) received the same dose followed by 750 mg t.i.d . for three consecutive days . Both groups were comparable regarding all risk factors . The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups . No significant differences in wound infection were observed between the two treatment groups : sternal site infection in the single-dose prophylaxis group was 14 % versus 13 % in the three-day course group ; donor site infection occurred in 38 % versus 39 % . It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection Objective To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for  surgical-site infections and remote infections such as respiratory tract infections ( RTIs ) and urinary tract infections ( UTIs ) . Methods The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local ( surgical wound ) and remote ( RTIs and UTIs ) infections  in a meta- analysis of r and omised controlled trials published between 1984 and 2003 . The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies . Results Evaluations were performed on 48 studies , for a total of 17 565 patients . Overall , 406 patients ( 4.8 % ) in the ceftriaxone group and 525 ( 6.3 % ) in the comparator group developed a surgical-site infection ( log odds ratio [ OR ] −0.30 [ CI −0.50 to −0.13 ] ; p < 0.0001 ) . RTIs were observed in 292 ( 6.01 % ) patients in the ceftriaxone group and in 369 ( 7.6 % ) patients in the comparator group , ( log OR −0.30 [ CI −0.55 to −0.09 ] ; p = 0.0013 ) . UTIs were reported for 2.2 % of the ceftriaxone prophylaxis patients compared with 3.74 % of the comparator group patients ( log OR −0.54 [ CI −1.18 to −0.16 ] ; p < 0.0001 ) . Overall , in clean surgery 195 ( 5.1 % ) and 234 ( 6.2 % ) patients developed a surgical site infection in the ceftriaxone and comparator groups , respectively ( log OR −0.22 [ CI −0.51 to 0.01 ] ; p = 0.0476 ) . RTIs were prevented for all but 1.57 % of patients in the ceftriaxone group and 2.62 % of patients in the comparator group ( p = 0.01 ) in clean surgery , and for 9.54 % of the ceftriaxone group versus 11.6 % of the comparator group ( p = 0.01 ) in clean-contaminated surgery . While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence ( log OR −0.21 [ CI 0.0–0.65 ] ; p = 0.7702 ) , this was clearly shown in the clean-contaminated surgery . In fact , 4.47 % of patients in the ceftriaxone group versus 7.52 % of patients in the comparator group developed a 
    Output:
    