Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

Abstract

Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection significantly. In 2018, the European Association for CardioThoracic Surgery (EACTS) provided clear guidance advising that third-generation cephalosporins are the first-line prophylactic antimicrobial of choice for cardiac surgery via median sternotomy as a result of their broad spectrum of activity and association with reduced postoperative mortality. Despite this guidance, it was believed that UK practice differed from this as a consequence of national concerns surrounding cephalosporins use and Clostridioides difficile infection. Methods: A survey was developed and distributed to all UK and Republic of Ireland (ROI) cardiac surgery centres in January 2019 to quantify this variation. Results: Of the 38 centres, 34 responded. Variation existed between the antimicrobial agent used, as well as the dosage, frequency and duration of suggested regimens even among centres using the same antimicrobial agent. The most common antimicrobial prophylaxis prescribed was a combination of flucloxacillin and gentamicin (16, 47%). Followed by cefuroxime (6, 17.6%) and cefuroxime combined with a glycopeptide (4, 11.7%). In patients colonised with methicillin-resistant Staphylococcus aureus or those with penicillin allergy gentamicin combined with teicoplanin was most common (42% and 50%, respectively). Discussion: This variation in antimicrobial agents and regimens may well contribute to the varying incidence of surgical site infection seen across the UK and ROI.

Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021

“…ЕОК IB (УУР C, УДД 4) Комментарии. Ванкомицин**, #тейкопланин (400-800 мг 1-2 введения в/в) [257] могут рассматриваться вместо цефазолина** в центрах, где высока резистентность стафилококков к оксациллину**, а также у пациентов высокого риска или при противопоказаниях к цефалоспоринам.…”

Surgical Site Infection in Cardiac Surgery

“…Importantly, when compared to cefazolin, the use of third-generation cephalosporins for PAP is associated with a 3-fold increase in post-operative infection incidence, longer hospital stays and increased treatment costs [ 15 , 63 ]. In patients at high risk for MRSA infection (colonised patients/patients infected with MRSA; history of MRSA colonisation/infection; stay at a hospital/facility/nursing home with a high prevalence of MRSA infections), vancomycin should be additionally administered [ 7 , 45 , 113 ]. Vancomycin dosage is 1–1.5 g i.v.…”

“…Recent recommendations do not advise prolonging PAP beyond 24 h, even if chest drainage is placed [ 46 , 66 , 106 , 110 , 118 , 119 ]. It is currently recognised that prolonged PAP, more than 24 h, does not reduce the risk of SSI, but it increases the risk of adverse effects of antibiotics, mainly associated with a disturbed function of the gastrointestinal tract (including Clostridioides difficile infections), kidneys, hematopoietic system and liver [ 10 , 17 , 113 , 118 , 120 , 121 ]. Perioperative antibiotic prophylaxis (PAP) in cardiac surgery has been presented in Table 2 .…”