(Circulation. 2000;101:2916.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance
Presented in part at the Ninth Annual Meeting of the Society of Healthcare Epidemiology of America, April 18–20, 1999, San Francisco, Calif.
From the Department of Epidemiology (S.H.), Harvard School of Public Health, and Division of Infectious Diseases (M.H.S., D.L., Y.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Dr Carmeli is now with the Division of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Dr Samore is at the Division of Infectious Diseases, University Hospital of Utah, Salt Lake City.
Correspondence to Stephan Harbarth, MD, MS, Division of Infectious Diseases, Enders Bldg 609, The Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail harbarth{at}a1.tch.harvard.edu
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 (<48 hours) versus prolonged (>48 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.
Key Words: bypass • infection • antibiotics
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