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 .
Antibiotic prophylaxis for cardiac surgery in Australia.
OBJECTIVE To evaluate national practice for antibiotic prophylaxis in cardiac surgery with respect to the use of protocol s , agent selection and duration of administration . DESIGN , SETTING AND PARTICIPANTS Two point-prevalence surveys of intensive care units in 24 public and 27 private hospitals performing cardiac surgery in Australia , conducted in 2004 and 2008 , using a structured telephone question naire of the attending senior intensive care clinician in each unit . MAIN OUTCOME MEASURES Existence of a protocol in the unit for antibiotic prophylaxis , specific antibiotic agents used and their duration of administration . RESULTS Between 2004 and 2008 , reported protocol use increased from 58 % to 80 % ( P = 0.02 ) , while concordance with version 13 of the Australian Therapeutic guidelines : antibiotic for both choice of agent and timing ( duration of administration ) remained around 10 % . Use of multiple agents was common , as was continued antibiotic administration after completion of surgery . Over 4 years , the proportion of cardiac surgical units reporting  vancomycin administration  for routine valve surgery prophylaxis doubled to 62 % ( P < 0.001 ) . CONCLUSION Despite an increase in reported protocol use for antibiotic prophylaxis in cardiac surgery , concordance with national antibiotic guidelines remained low , with duration of antibiotic administration deviating most from recommendations . Prophylactic  vancomycin  use appears to have increased substantially in recent years . Clinical implementation of recommended perioperative cardiac surgical antibiotic prophylaxis may not occur until supported by evidence from either a large prospect i ve r and omised study or st and ardised national surveillance of cardiac surgical site infection rates
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 .