There was no advantage of regimens lasting > 48 h post-operation .
In the comparison of glycopeptides versus β-lactams , an advantage of glycopeptides was observed when comparators were given for similar duration and for β-lactams when given for a longer duration than the glycopeptides .
There was no significant advantage of high antibiotic dosing .
Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively
BACKGROUND Antibiotic prophylaxis is recommended in cardiac surgery .
Current debate concerns the type of antibiotic(s ) , dosing and the duration of prophylaxis .
Cardiac surgery in a high-risk group of patients: is prolonged postoperative antibiotic prophylaxis effective?
OBJECTIVE In a prospect i ve , r and omized study , postoperatively prolonged antibiotic prophylaxis is evaluated in a high-risk group of patients undergoing cardiac operations . These patients had postoperative low cardiac output necessitating inotropic support and intraaortic balloon pumping . METHODS Between January 1991 and 1994 , 53 patients were enrolled in the study ( 42 men , mean age 65 years ) . All patients received the usual perioperative ( 24 hours ) cefazolin prophylaxis . In the study group ( n = 28 ) a prolonged regimen of prophylaxis with ticarcillin/clavulanate was performed for 2 days and vancomycin was added in a low dose until removal of the intraaortic balloon pump . The control group ( n = 25 ) did not receive a prolonged regimen of prophylaxis . Follow-up ended at hospital discharge . RESULTS Early mortality was 7 of 28 patients ( 25 % ) in the prophylaxis group and 8 of 25 patients ( 32 % ) in the control group ( p = 0.397 ) . Defined infections ( pneumonia , n = 22 ; sepsis , n = 8 ; deep sternal wound infection , n = 2 ) occurred in 50 % of the study group and 68 % of the control group ( p = 0.265 ) . In all patients with septicemia , only coagulase-negative staphylococci could be isolated from the bloodstream ( 5 patients in the prophylaxis group vs 3 in the control group ) . Infectious parameters were controlled daily and did not differ significantly between groups . A total of 1158 bacteriologic tests were performed ( blood cultures , n = 389 ; intravascular catheters , n = 208 ; bronchial aspirates , n = 411 ; intraaortic balloon pumps , n = 42 ; wound secretions , n = 108 ) showing bacterial growth in 322 ( 28 % ) without a significant difference between the groups . In the prophylaxis group , 13 intravascular catheters and intraaortic balloon pumps showed bacterial growth versus 11 in the control group . No side effects were seen . CONCLUSIONS In a high-risk group of patients undergoing cardiac operations , infectious outcome could not be effectively influenced by an additional and prolonged postoperative prophylaxis regimen with low-dose vancomycin and ticarcillin/clavulanate . Low-dose vancomycin did not reduce the rate of infections or colonizations of intravascular catheters with gram-positive organisms
There was no advantage of regimens lasting > 48 h post-operation .
In the comparison of glycopeptides versus β-lactams , an advantage of glycopeptides was observed when comparators were given for similar duration and for β-lactams when given for a longer duration than the glycopeptides .
There was no significant advantage of high antibiotic dosing .
Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively
BACKGROUND Antibiotic prophylaxis is recommended in cardiac surgery .
Current debate concerns the type of antibiotic(s ) , dosing and the duration of prophylaxis .