Abstract
Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.
Highlights
Background and ObjectivesDuration of antibiotic prophylaxis for cardiac surgery is still debated and controversial
The following parameters were extracted from the local database which is registred at the French National Commission Informatics and Liberty: sex, age, body mass index, cardiovascular risk factors, presence of chronic obstructive pulmonary disease (COPD), chronic renal insufficiency, peripheral vascular disease, type of cardiac surgery [coronary artery bypass graft (CABG) ± valve replacement (VR), VR and other], use of 1 or 2 internal thoracic arteries, Euroscore I [5], duration of ICU length of stay, prolonged mechanical ventilation (≥48 hours), use of noninvasive ventilation, red-cell transfusion, vasopressor use, rate of acute renal insufficiency, dialysis required
Mortality rate for severe SSI was 35.7% for the study period. The results of this retrospective study showed that intraoperative cefamandole prophylaxis was as effective as 24-hour administration to prevent the most severe surgical site infections after adult cardiac surgery, deep sternal wound infection (DSWI) and endocarditis
Summary
Background and ObjectivesDuration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery
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