title: [Anti-infection prophylaxis in cardiac surgery: comparison of single-dose ceftriaxone and cefamandole in repeat doses]. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Ceftriaxone versus vancomycin prophylaxis in cardiovascular surgery. Aortocoronary bypass procedures and sternotomy infections: a study of antistaphylococcal prophylaxis. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Comparison of ceftriaxone and cefazolin prophylaxis against infection in open heart surgery. Comparative efficacy of teicoplanin and cefazolin for cardiac operation prophylaxis in 3027 patients. The ESPRIT Group. Prospective randomised comparison of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery bypass grafting Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis Antibiotic prophylaxis in cardiac operations. Cardiac surgery in a high-risk group of patients: is prolonged postoperative antibiotic prophylaxis effective? Ceftriaxone vs cefuroxime for infection prophylaxis in coronary bypass surgery. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery.
abstract: The efficiency of a single two gram bolus of Ceftriaxone for cardiac operations was evaluated versus a classical , multiple dose , antibiotic prophylaxis using Cefam and ole . The results were quite similar in both groups , with a very low infection rate . We conclude that a single bolus prophylaxis using a broad spectrum antibiotic is as efficient as an ordinary , multiple dose technique 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 prospect i ve 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 The efficacy of antibiotic prophylaxis in cardiac surgery was compared between 97 patients receiving a single 2 g dosage of ceftriaxone and 103 receiving 500 mg of vancomycin i.v . every 6 h for 48 h. The overall infection rate was 13.4 % in the ceftriaxone and 10.7 % in the vancomycin group . Four ( 4 % ) wound infections , including one mediastinitis , occurred in the ceftriaxone group and five ( 5 % ) in the vancomycin group , with no statistically significant difference . The findings of this study support the adequacy of a simple single dose of ceftriaxone prophylaxis in cardiac surgery , at least in hospitals with low incidence of vancomycin-resistant staphylococcal infections In a prospect i ve study of cephalothin prophylaxis for patients who underwent aortocoronary bypass an unacceptably high rate ( 44 % ) of Staphylococcus aureus sternotomy infections occurred in a placebo-treated group . In two other groups of patients , one group given cephalothin intraoperatively and the other given the antibiotic both intra- and postoperatively , such infections occurred with similar frequency ( 2.6 % and 2.1 % respectively ) . This study demonstrates the need for  antistaphylococcal agents  during aortocoronary bypass operation . No advantage is derived by extending this therapy beyond the operative period HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54.8%-56.6 % ) of patients within 1 hour before incision .  Antimicrobial agents consistent with published guidelines were administered to 92.6 % ( 95 % CI , 92.3%-92.8 % ) of the patients .  Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7 % ( 95 % CI , 40.2%-41.2 % ) of patients . CONCLUSION Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery One hundred four patients undergoing elective open heart surgery were enrolled in a prospect i ve , double-blind trial comparing prophylaxis against infection using a single 1 g dose of ceftriaxone and seven doses of cefazolin . Patients in both groups had similar risk factors for infection . The likelihood of achieving a tissue concentration in excess of the minimal inhibitory concentration for Staph . aureus was significantly greater with ceftriaxone in atrial appendage ( p less than 0.001 ) , muscle ( p less than 0.01 ) , and bone ( p less than 0.01 ) than with cefazolin . The serum half-life of ceftriaxone was approximately 15.7 hours . All 49 serum sample s obtained 18 to 24 hours after delivery of ceftriaxone and 26 of 33 sample s obtained 40 to 48 hours after delivery had drug concentrations in excess of 3.1 micrograms/ml , the mean minimal inhibitory concentration for isolates of Staph . aureus . Early and late infectious complications were infrequent and occurred at similar rates in both groups . Neither drug was associated with significant toxicity . A single 1 g dose of ceftriaxone was as effective and safe as multiple doses of cefazolin and demonstrated superior tissue penetration OBJECTIVE Cephalosporins , especially cefazolin , are widely used in the prevention of postoperative wound infections after cardiac operations . As more and more Staphylococcus aureus and Staphylococcus epidermidis strains are becoming resistant to cephalosporins and other antibiotics , alternative agents , such as glycopeptides , are often used as prophylaxis . We performed a multicenter double-blind r and omized controlled trial comparing teicoplanin , a glycopeptide antibiotic , with cefazolin . METHODS A total of 3027 adult patients undergoing elective coronary artery bypass grafting , valve operations , or both were r and omized to a single dose of teicoplanin ( 15 mg/kg ) or a 2-day course of cefazolin ( 2 g initial dose , followed by 1 g every 8 hours for 6 more doses ) . Patients were followed up for a total of 6 months postoperatively . The primary objective was to compare , between groups , the incidence of surgical infections up to 30 days postoperatively . Secondary objectives were incidence of other infections , other complications , and death . RESULTS A total of 3027 patients were r and omized to receive either teicoplanin ( n = 1518 ) or cefazolin ( n = 1509 ) . Thirty days postoperatively , there was a trend to more deep sternotomy wound infections in the teicoplanin group ( 31 vs 18 , P = . 087 ) , which became significant by 6 months ( 36 vs 19 , P = .032 ) . One hundred percent of the gram-positive strains infecting patients were susceptible to teicoplanin , whereas 8.3 % were resistant to cefazolin . Pneumonia and urinary tract infections were more common in the teicoplanin group . Deep wound infections of the leg were more common in the cefazolin group . CONCLUSIONS Cefazolin was more effective prophylaxis than teicoplanin against postoperative wound infections after elective cardiac operations . Infection rates were low with either treatment To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting , 1,016 consecutive patients were prospect ively r and omized to receive either a single dose or a three-day course of cefuroxime . Nine patients ( 0.9 % ) died within seven days ; no death was caused by infection . For various reasons 163 other patients were not evaluable . Therefore , 844 patients were evaluated . Patients in group A ( n=419 ) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia ; group B ( n=425 ) received the same dose followed by 750 mg t.i.d . for three consecutive days . Both groups were comparable regarding all risk factors . The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups . No significant differences in wound infection were observed between the two treatment groups : sternal site infection in the single-dose prophylaxis group was 14 % versus 13 % in the three-day course group ; donor site infection occurred in 38 % versus 39 % . It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection Objective To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for  surgical-site infections and remote infections such as respiratory tract infections ( RTIs ) and urinary tract infections ( UTIs ) . Methods The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local ( surgical wound ) and remote ( RTIs and UTIs ) infections  in a meta- analysis of r and omised controlled trials published between 1984 and 2003 . The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies . Results Evaluations were performed on 48 studies , for a total of 17 565 patients . Overall , 406 patients ( 4.8 % ) in the ceftriaxone group and 525 ( 6.3 % ) in the comparator group developed a surgical-site infection ( log odds ratio [ OR ] −0.30 [ CI −0.50 to −0.13 ] ; p < 0.0001 ) . RTIs were observed in 292 ( 6.01 % ) patients in the ceftriaxone group and in 369 ( 7.6 % ) patients in the comparator group , ( log OR −0.30 [ CI −0.55 to −0.09 ] ; p = 0.0013 ) . UTIs were reported for 2.2 % of the ceftriaxone prophylaxis patients compared with 3.74 % of the comparator group patients ( log OR −0.54 [ CI −1.18 to −0.16 ] ; p < 0.0001 ) . Overall , in clean surgery 195 ( 5.1 % ) and 234 ( 6.2 % ) patients developed a surgical site infection in the ceftriaxone and comparator groups , respectively ( log OR −0.22 [ CI −0.51 to 0.01 ] ; p = 0.0476 ) . RTIs were prevented for all but 1.57 % of patients in the ceftriaxone group and 2.62 % of patients in the comparator group ( p = 0.01 ) in clean surgery , and for 9.54 % of the ceftriaxone group versus 11.6 % of the comparator group ( p = 0.01 ) in clean-contaminated surgery . While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence ( log OR −0.21 [ CI 0.0–0.65 ] ; p = 0.7702 ) , this was clearly shown in the clean-contaminated surgery . In fact , 4.47 % of patients in the ceftriaxone group versus 7.52 % of patients in the comparator group developed a UTI ( log OR −0.56 [ CI −1.25 to −0.16 ] ; p < 0.0001 ) . Adverse events were observed in a similar proportion in the ceftriaxone prophylaxis and the comparator groups ( 0.35 % and 0.23 % , respectively ) . Duration of prophylaxis did not influence outcome of infection . Conclusions The meta- analysis showed that ceftriaxone is statistically superior to other antibiotics in preventing both local and remote postoperative infections This clinical trial , which was composed of 1,031 adults undergoing cardiac operations , compared the efficacy of a single dose of 1 g of ceftriaxone with a 48-our regimen consisting of flucloxacillin and gentamicin . There was no significant difference ( p = 0.89 ) in the overall incidence of major infections : 30 of 515 patients ( 5.8 % ; 95 % confidence interval , 5.4 % to 6.2 % ) taking ceftriaxone and 29 of 516 patients ( 5.6 % ; 95 % confidence interval , 5.2 % to 6.0 % ) taking flucloxacillin and gentamicin . Subgroup analyses , with a lower statistical power , failed to show a significant difference between patients who received ceftriaxone and those who received flucloxacillin/gentamicin :  major sternal wound infections arose in 2.7 % of the patients taking ceftriaxone versus 1.6 % in those on the 48-hour regimen ( p = 0.20 ) and major limb wound infections arose in 4.2 % and 5.4 % , respectively ( p = 0.44 ) . Single-dose prophylaxis was associated with fewer intravenous administrations ( 864 doses versus 9,570 doses ) and cost less ( A$ 17,248 versus A$ 78,510 ) . Although the regimen that included gentamicin was associated with the greatest biochemical impairment of renal function , the overall toxicity for both groups was low . We conclude that a single dose of ceftriaxone provided cost-efficient prophylaxis for adults undergoing cardiac operations when compared with a 48-hour regimen of gentamicin and flucloxacillin . The general principle revealed by our data is that the short-term administration of an appropriate antibiotic regimen represents optimal prophylaxis for patients undergoing cardiac procedures 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 The most serious infection after coronary artery bypass grafting ( CABG ) is mediastinitis following deep sternal wound infection . Antibiotic prophylaxis for at least 48 hours has been recommended . In this trial 551 consecutive patients were r and omized to receive ceftriaxone in a single dose or cefuroxime thrice daily until the end of the second postoperative day . The overall infection rate was 7.7 % in the ceftriaxone and 8.3 % in the cefuroxime group , and the incidence of deep sternal infection was 2.9 % in both groups . Significant risk factors for such infection were chronic respiratory disease ( p < 0.001 ) and diabetes ( p < 0.01 ) . The antibiotic prophylaxis had no harmful effects on the colonic flora in either group . Acquisition and delivery costs for the prophylactic agents were three times higher in the cefuroxime than in the ceftriaxone group . Both antibiotics are concluded to be equally safe and effective . Single-dose ceftriaxone prophylaxis is as effective as cefuroxime given for 48 hours postoperatively . Single-dose ceftriaxone is also simple to use BACKGROUND The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Data base ( STS NCD ) was developed nearly 2 decades ago . Since its inception , the number of participants has grown dramatically , patient acuity has increased , and overall outcomes have consistently improved . To adjust for these and other changes , all STS risk models have undergone periodic revisions . This report provides a detailed description of the 2008 STS risk model for coronary artery bypass grafting surgery ( CABG ) . METHODS The study population consisted of 774,881 isolated CABG procedures performed on adult patients aged 20 to 100 years between January 1 , 2002 , and December 31 , 2006 , at 819 STS NCD participating centers . This cohort was r and omly divided into a 60 % training ( development ) sample and a 40 % test ( validation ) sample . The development sample was used to identify predictor variables and estimate model coefficients . The validation sample was used to assess model calibration and discrimination . Model outcomes included operative mortality , renal failure , stroke , reoperation for any cause , prolonged ventilation , deep sternal wound infection , composite major morbidity or mortality , prolonged length of stay ( > 14 days ) , and short length of stay ( < 6 days and alive ) . C and i date predictor variables were selected based on their availability in versions 2.35 , 2.41 , and 2.52.1 of the STS NCD and their presence in ( or ability to be mapped to ) version 2.61 . Potential predictor variables were screened for overall prevalence in the study population , missing data frequency , coding concerns , bivariate relationships with outcomes , and their presence in previous STS or other CABG risk models . Supervised backwards selection was then performed with input from an expert panel of cardiac surgeons and biostatisticians . After successfully validating the fit of the models , the development and validation sample s were subsequently combined , and the final regression coefficients were estimated using the overall combined ( development plus validation ) sample . RESULTS The c-index for the mortality model was 0.812 , and the c-indices for other endpoints ranged from 0.653 for reoperation to 0.793 for renal failure in the validation sample . Plots of observed versus predicted event rates revealed acceptable calibration in the overall population and in numerous subgroups . When patients were grouped into categories of predicted risk , the absolute difference between the observed and expected event rates was less than 1.5 % for each endpoint . The final model intercept and coefficients are provided . CONCLUSIONS New STS risk models have been developed for CABG mortality and eight other endpoints . Detailed descriptions of model development and testing are provided , together with the final algorithm . Overall model performance is excellent OBJECTIVE Use of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance , lower costs , and fewer problems with drug toxicity and superinfections . We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures . METHODS This r and om , prospect i ve , clinical study included 838 adult patients undergoing elective coronary artery bypass grafting , valve operations , or both . These patients were r and omly given a single dose of cefazolin ( 2 g ) or a 24-hour treatment ( 2-g initial dose , followed by 1 g every 8 hours ) . Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria . Patient clinical and demographic characteristics were noted , with follow-up for 12 postoperative months . The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively . RESULTS A total of 419 patients received single-dose cefazolin , and another 419 received the 24-hour treatment . Surgical site infection occurred in 35 ( 8.3 % ) patients receiving single doses and 15 ( 3.6 % ) patients administered the 24-hour treatment ( P = .004 ) . We identified no differences between groups for mortality or duration of hospitalization ( preoperative hospitalization , intensive care unit stay , and hospitalization after surgical intervention ) . The microorganisms isolated showed a similar distribution in both groups . The germs isolated were gram-positive cocci in 86 % of the surgical site infections . CONCLUSIONS Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour , multiple-dose cefazolin regimen
target: There were no statistically significant differences in mortality , infections overall and adverse events .
  Perioperative antibiotic prophylaxis of ≥24 hours may be more efficacious in preventing sternal SSIs in patients undergoing cardiac surgery compared to shorter regimens .
background: OBJECTIVE We aim ed to compare the efficacy of short-term ( < 24 hours ) versus longer-term antibiotic prophylaxis ( ≥24 hours ) in open heart surgery .
  BACKGROUND The optimal duration of antibiotic prophylaxis for adults undergoing cardiac surgery is unknown and guideline recommendations are inconsistent .