Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance

Abstract

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 (Ͻ48 hours) versus prolonged (Ͼ48 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 prospective 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.

Vascular Graft Infection: A Single Centre Analysis

“…Good prophylaxis given on time (with the first skin cut) and with the right agent upon the ATB centre consultation is a must. Single dose prophylaxis seems to give the best results [20][21][22]. Pre-operative hospital stay should be minimized.…”

Prevalência de infecções em suturas de cirurgias de revascularização do miocárdio

“…In the study by Harbarth et al [9], superficial infections detected in 231, culture was performed in 76% (176). In 70% (123 of 176) of which there was growth of microorganisms of which: 52 were coagulase-negative staphylococci, 21 enterococci and 51 Gram-negative, and S. aureus was not frequently found (n = 15).…”

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

“…Multiple studies have been published in the orthopaedic literature comparing the results of drainage with no drainage [ [56]. In the orthopaedic literature, one study compared the efficacy of a single preoperative dose of cefazolin with one preoperative and two postoperative doses of cefuroxime at 8 and 16 hours in joint arthroplasties [123].…”

“…If an antibiotic penetrates the wound being drained, its concentration is lower than the serum concentration and may be below the minimum inhibitory concentration [85]. In addition, several studies suggest prolonged use of postoperative antibiotics may actually increase infection rates [78,127] and promote antibiotic resistance [56].…”