Abstract
BackgroundThis study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs.MethodsAll adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis.ResultsThe incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD).ConclusionIn conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.
Highlights
This study investigated the efficacy of first-generation and third-generation prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitali‐ zations, and medical costs
Patients with current active infections; those for whom antibiotics had been administered within two weeks of surgery; immunotherapy patients; patients with congenital heart disease, cardiac assistive devices, or extracorporeal membrane oxygenation (ECMO); and patients who had undergone aortic dissection or thoracotomy surgeries were excluded from the study
Among the 554 heart surgery procedures performed between January 2009 and December 2016, the general characteristics of 482 study subjects were compared before propensity score matching (PSM) and 388 patients after matching
Summary
This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitali‐ zations, and medical costs. In a placebo-controlled trial, the placebo group showed an increased incidence of surgical site infections by 20–50%, confirming the appropriateness of using prophylactic antibiotics in cardiac surgery [1,2,3]. Since the start of the national hospital evaluation program (NHEP) in 2008, the evaluation of prophylactic antibiotics for surgery was implemented as a comprehensive measure of antibiotic resistance management In this evaluation program, unfavorable antibiotic choices were defined as the overuse of third-generation cephalosporin, aminoglycoside, combination of β-lactam with aminoglycoside, combination of vancomycin and other antibiotics. Procedures performed since 2008 were included in the NHEP assessment and the clinical performance results were officially reported to the public as well as to each hospital
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