<b>Antimicrobial Regime for Cardiac Surgery</b>
: The Safety and Effectiveness of Short-Course Flucloxacillin (or Teicoplanin) and Gentamicin-Based Prophylaxis

White, Ralph W. deVere; West, Robert; Howard, Philip; Sandoe, Jonathan

doi:10.1111/jocs.12155

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…Moreover, we used a restrictive C difficile definition as previously described 16 and found the same results when using a more inclusive ICD-9 only definition, illustrating the robustness of our findings. Adding to this, but also illustrating the heterogeneity in populations, our C difficile prevalence estimates are comparable to some 27 but not other studies demonstrating higher prevalences. 5,17 Given the limitations pertaining to the use of billing data to answer clinical questions, we believe that our study provides some useful insights.…”

Section: Discussionsupporting

confidence: 84%

“…2,17,27 Traditionally, the prevention of surgical site infections is considered the main objective of antibiotic prophylaxis. However, a recent study shifted the focus to other infections after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…10–12,14 Moreover, guidelines, however complete, may not always be applicable to every situation. White and colleagues 27 have recently described their institutional transition from cephalosporin-based antimicrobial prophylaxis for cardiac surgery to flucloxacillin (or teicoplanin) and gentamicin after several apparent prophylaxis failures, continued institutional presence of methicillin-resistant staphylococcus aureus, and ongoing problems with C difficile . They found their practice change to have decreased C difficile without changing the incidence of wound infections or renal complications.…”

Section: Discussionmentioning

confidence: 99%

“…They found their practice change to have decreased C difficile without changing the incidence of wound infections or renal complications. 27 …”

Section: Discussionmentioning

confidence: 99%

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Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

Poeran

Mazumdar

Rasul

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objective Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for Clostridium difficile. Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. We aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and C difficile among patients undergoing coronary artery bypass grafting. Methods We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006–2013, n = 154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2 days, “standard” vs ≥2 days, “extended”) and (2) type of antibiotic used (“cephalosporin,” “cephalosporin + vancomycin,” “vancomycin”) and C difficile as outcome. Results Overall C difficile prevalence was 0.21% (n = 329). Most patients (59.7%) received a cephalosporin only; in 33.1% vancomycin was added, whereas 7.2% received vancomycin only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased C difficile risk (odds ratio, 1.43; confidence interval, 1.07–1.92), whereas no significant associations existed for vancomycin use as adjuvant or primary prophylactic compared with the use of cephalosporins (odds ratio, 1.21; confidence interval, 0.92–1.60, and odds ratio, 1.39; confidence interval, 0.94–2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5–35.7), use of adjuvant vancomycin (interquartile range, 4.2–61.1), and vancomycin alone (interquartile range, 2.3–10.4). Conclusions Although extended use of antibiotic prophylaxis was associated with increased C difficile risk after coronary artery bypass grafting, vancomycin use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce C difficile risk.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…They found their practice change to have decreased C difficile without changing the incidence of wound infections or renal complications. 27 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

Poeran

Mazumdar

Rasul

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…Antimicrobial prophylaxis is one of the most important measures to reduce the incidence of SSI (Hamouda et al, 2015; Kreter and Woods, 1992; Luo et al, 2015; NICE, 2019; White et al, 2013) alongside non-pharmacological measures such as preoperative decontamination therapy, aseptic surgical technique and glucose control (Cardiothoracic Interdisciplinary Research Network et al, 2020). However, the evidence base underpinning these interventions is limited (Cardiothoracic Interdisciplinary Research Network et al, 2019) and a national survey indicates significant variation in non-pharmacological practices to prevent SSI after cardiac surgery (Cardiothoracic Interdisciplinary Research Network et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

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

Ackah

Neal

Marshall

et al. 2020

Journal of Infection Prevention

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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.

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Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

Diemberger

Boriani

Deharo

2020

Infections of Cardiac Implantable Devices

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Antimicrobial Regime for Cardiac Surgery : The Safety and Effectiveness of Short-Course Flucloxacillin (or Teicoplanin) and Gentamicin-Based Prophylaxis

Abstract: The change from multidose cephalosporin prophylaxis to short-course flucloxacillin (or teicoplanin) and gentamicin was not associated with an increase in renal complications, and resulted in significantly fewer CDIs, with no significant change in the incidence of wound infections.

Cited by 8 publications

References 15 publications

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

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

Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

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