Another "Yes" Vote for Shortening Perioperative Antibiotic Prophylaxis

Generally, surgeons are gravitating toward shorter courses of antibiotics for surgical prophylaxis to reduce toxicity, selection of resistant organisms, Clostridium difficile infection, and cost. Some features related to cardiac surgery—the increased likelihood of bacteria from the graft site during saphenous vein autograft, more serious consequences if implants become infected, and a host of other factors—make perioperative antibiotic prophylaxis (PAB) critical in this field.

Guidelines differ in their recommendations about which antibiotic to use, when to give the first dose and how long to continue prophylaxis. Dosing regimens are often based on past experience or institutional preference. A new study that reviewed 1096 consecutive cardiac surgery patients indicates that reducing the PAB duration may save money and provide sufficient antibacterial coverage.

These researchers looked at adult patients who underwent cardiac surgery during calendar year 2001. One group received PAB with a second-generation cephalosporin for 56 hours (n=283), while the other received the same PAB but for 32 hours (n=332). Patients were similar in all regards. The researchers examined surgical site infections in both groups, and also looked at respiratory infection, urinary tract infection, and mortality rate as secondary endpoints.

They found no statistically significant differences in primary and secondary endpoints. Treatment groups had similar rates of monitored infection types, and mortality.

Female sex, increasing age, peripheral arterial obstructive disease, longer operating-time, longer ICU stays, transfusion, and respiratory insufficiency were associated with a greater likelihood of nosocomial infections. Most surgeons acknowledge these patients are high-risk. Targeting them for perioperative intervention strategies could reduce infection rates.

Previous studies have failed to find significant differences in mortality and overall infection rates with shorter PAB durations, but their results have been limited by diverse antibiotic regimens and potential bias issues.

The researchers conclude that reducing the duration of PAB adult cardiac surgery patients did not increase the nosocomial infection rate. They suggest it might reduce antibiotic resistance and health care costs. This study appears in the February issue of the Journal of Cardiothoracic Surgery.