Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. Antibiotic prophylaxis for cardiac surgery in Australia. Cardiac surgery in a high-risk group of patients: is prolonged postoperative antibiotic prophylaxis effective? Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room. Optimizing the timing of antimicrobial prophylaxis in surgery: an intervention study. Antibiotic prophylaxis in abdominal hysterectomy, with special reference to the duration of the prophylaxis Antibiotic prophylaxis in cardiac operations. Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines. Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis. Ceftriaxone vs cefuroxime for infection prophylaxis in coronary bypass surgery. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study. [Value of short prophylactic antibiotherapy in thoracic and vascular surgery. Comparative randomized double-blind study of 3 and 8 injections of cefamandole]. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial Antibiotic prophylaxis in permanent pacemaker implantation: a prospective randomised trial. Antibiotics in trauma and orthopedic surgery -- a primer of evidence-based recommendations. Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery.
BACKGROUND Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection ( SSI ) . Inappropriate antimicrobial prophylaxis , such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen , can increase the prevalence of antibiotic resistant strains , prolong hospital stay , cause adverse reactions , and negatively affect an institution 's pharmacy budget for antibiotics . In developing countries such as Jordan , where the role of clinical pharmacists is still in its primary stages , the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement . OBJECTIVE To assess the degree of adherence to international guidelines for antimicrobial prophylaxis practice in cardiac surgery performed at Queen Alia Heart Institute ( QAHI ) in Amman , Jordan , as part of an attempt to determine opportunities for clinical pharmacist intervention . METHODS For a total of 236 patients who were admitted for cardiac surgery to QAHI - the only official referral hospital for cardiac patients in Jordan - between November 19 , 2006 , and January 22 , 2007 , the antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were assessed against 3 international guidelines using a pre-tested , structured clinical data collection form that was completed by 2 of the authors who work at QAHI . The study design was prospect i ve . All patients who were scheduled for surgery were monitored daily during their inpatient stay until discharge and then were tracked in the outpatient clinic for 2 months following surgery . Data regarding antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were collected during the patient 's inpatient stay ; data collection was performed periodically thereafter as data became available until the end of the 2-month follow-up . The 3 guidelines agreed that ( a ) antimicrobial prophylaxis should be given to all patients undergoing cardiac surgeries ; ( b ) the first- or second-generation cephalosporins ( cefazolin or cefuroxime ) are the antibiotics of choice , and vancomycin use is reserved for cases of allergy to beta-lactams or if presumed or known methicillin-resistant Staphylococcus aureus ( MRSA ) colonization is present ; ( c ) the timing of the first dose should be within 60 minutes prior to the skin incision ; and ( d ) the duration of antimicrobial prophylaxis should not be longer than 48 hours . RESULTS Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients . For the 6 evaluated criteria , ( 1 ) indication : in 100 % of patients the appropriate decision was made to use antimicrobial prophylaxis in concordance with guidelines ; ( 2 ) choice : only 1.7 % of patients received the antibiotic of choice ; ( 3 ) duration : 39.4 % of patents received antimicrobial prophylaxis for a total duration of 48 hours or less in concordance with guidelines , and for 58.9 % of patients , duration was longer than recommended ; ( 4 ) dose : 27.9 % of patients received an appropriate dose ; ( 5 ) dosing interval : only 13.0 % of patients received an appropriate dosing interval , and none of the doses of antimicrobial prophylaxis used at induction of anesthesia was repeated in operations that lasted longer than the half-life of the antibiotic used ; and ( 6 ) timing : 99.1 % of patients received antimicrobial prophylaxis dose within 60 minutes prior to skin incision as recommended by guidelines , but 97.0 % of patients received an unnecessary midnight dose of intravenous antibiotic the night before surgery . CONCLUSION Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in QAHI , leading to the inappropriate administration of many antibiotics . Developing local hospital guidelines , as well as giving the clinical pharmacist a central role in the administration , monitoring , and intervention of antimicrobial prophylaxis may improve the current practice 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 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 OBJECTIVE To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations . DESIGN R and omized , controlled , evaluator-blinded trial . SETTING University-affiliated hospital . PATIENTS Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin , unless they were receiving therapeutic antibiotics at the time of surgery . INTERVENTION R and omization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics ( reminder group , n = 137 ) or control ( n = 136 ) . After another 30 minutes , the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered . RESULTS Intraoperative redosing was significantly more frequent in the reminder group ( 93 of 137 ; 68 % ) than in the control group ( 55 of 136 ; 40 % ) ( adjusted odds ratio , 3.31 ; 95 % confidence interval , 1.97 to 5.56 ; P < .0001 ) . The impact of the reminder was even greater when compared with the 6 months preceding the study period ( 129 of 480 ; 27 % ; P < .001 ) , suggesting some spillover effect on the control group . Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing . The rate of surgical-site infection in the reminder group ( 5 of 137 ; 4 % ) was similar to that in the control group ( 8 of 136 ; 6 % ; P = .42 ) , but significantly lower than that in the pre- study period ( 48 of 480 ; 10 % ; P = .02 ) . CONCLUSION The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis The timing of surgical antimicrobial prophylaxis  was determined before and after an intervention programme of education of surgeons , anaesthetists and nurses on the subject of antimicrobial drug prophylaxis , and the subsequent implementation of new protocol s of single dose prophylaxis administered within one hour before incision . This prospect i ve study was performed in three surgical departments of a university hospital . For comparison , the timing of prophylaxis was also determined in an operating department of a community hospital . The timing improved considerably in the departments of the university hospital where the intervention was carried out : administration of the first dose within one hour before incision increased from 39 % to 69 % in department A and from 64 % to 80 % in department B. Before the intervention , seven out of 16 prophylactic doses were given after inflation of the tourniquet . After the intervention all doses of prophylactic antibiotics were administered before inflation of the tourniquet . Initially , the intervals of multidose prophylaxis varied widely . In the second review , single-dose prophylaxis increased from 21 % to 78 % in department A and from 31 % to 85 % in department B. We conclude that the intervention succeeded in improving the quality of surgical prophylaxis Two consecutive open studies were performed of the efficacy of a prophylactic cefuroxime/metronidazole combination  in abdominal hysterectomy . The first group received a 24-h regimen , the second group a  single pre-operative dose . The incidence of post-operative wound infections and urinary tract infections were similar in both groups [ wound infections in 1/75 versus 2/84 patients ( NS ) , urinary tract infections 4/75 versus 3/84 patients ( NS ) , respectively , in the 24-h group and single-dose group ] . No significant differences in other parameters , such as pyrexia and duration of post-operative hospitalization , could be detected 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 The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis . Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and /or gynaecological procedures , not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis . This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from " r and omly occurring " bacteremia ( e.g. , from brushing teeth ) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective . A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implication s is presented BACKGROUND The purpose of this study was to assess the value of tracheal aspirate as a predictor of pneumonia after coronary artery bypass grafting and to evaluate the efficacy of prolonged perioperative antibiotic prophylaxis . METHODS Tracheal aspirates of 500 patients undergoing coronary artery bypass grafting were taken immediately after intubation and analyzed for microorganisms by Gram stain and semiquantitative microbiologic cultures . All patients received 2 g ceftriaxone as a single-dose perioperative antibiotic prophylaxis before operation . Results of Gram stains were available before the patients were transferred to the intensive care unit . After the results were known , both groups of patients ( positive Gram stain , group 1 ; negative Gram stain , group 2 ) were r and omly assigned to either conventional antibiotic prophylaxis ( A ) , consisting of ceftriaxone 2 g on postoperative day 1 , or prolonged antibiotic prophylaxis ( B ) , with ticarcillin + clavulanic acid 3 x 5.2 g during 72 hours . RESULTS From 500 patients , 91 had a positive Gram stain whereas 409 had a negative one . The incidence of pneumonia was significantly higher in patients with preoperative positive tracheal aspirates ( 15.3 % ) than in patients with a negative one ( 3.6 % ; p < 0.01 ) . However , prolonged prophylaxis did not reduce the rate of postoperative pneumonia , which was as high as 13 % in untreated positive patients versus 17 % in treated positive patients , and 2 % in untreated negative patients versus 4 % in treated patients . In patients who had pneumonia , there was a high correlation between the microorganisms found in preoperative aspirates and those observed when aspirates were repeated ( 100 % correlation in patients with conventional antibiotic prophylaxis and 87 % in those with prolonged prophylaxis ) . CONCLUSIONS Early postoperative pneumonia ( < 7 days ) is most likely caused by microorganisms that colonize the respiratory tract before operation . The risk of pulmonary infection after coronary artery bypass grafting can be predicted from the preoperative tracheal aspirates . Prolonged perioperative antibiotic prophylaxis has no efficacy in reducing the incidence of pulmonary infections 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 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 In a prospect i ve r and omized double-blind study of 141 patients referred for reconstructive vascular surgery on the abdominal aorta and the lower extremities , placebo was compared to antibiotic prophylaxis . The prophylaxis group received three doses of a combination of methicillin , 2 g and netilmicin , 200 mg . Antibiotic prophylaxis reduced postoperative wound infections as compared to placebo , i.e. 4/69 ( 5.8 % ) vs. 12/72 , ( 16.7 % ) respectively ( P = 0.04 ) . No graft infections occurred . Two cases of postoperative septicaemia were seen in the placebo group , none in the antibiotic group . Among different procedures aortic-femoral bypass operations showed the highest wound infection rates . The two treatment groups were comparable with regard to all other postoperative complications registered , including nephro- and ototoxicity . The antibiotic regimen was considered safe , but had only marginal value as prophylaxis in vascular reconstructive surgery on the abdominal aorta and the lower extremities The subject of whether an optimal duration of prophylactic antibiotic therapy exists was evaluated by comparing results of short and medium-term treatment in aseptic surgery during a double-blind , r and omized , prospect i ve trial in 507 patients undergoing vascular or thoracic operations . Patients were r and omly allocated to receive either 3 injections of cefam and ole : at induction of anesthesia and after 4 and 10 hours ( 251 cases ) or 8 injections of the same antibiotic : at induction of anesthesia , after 4 hours and then every 6 hours up to 40 hours ( 256 cases ) . Evaluation on discharge showed that among the 251 patients receiving 3 injections , 21 ( 8.33 % ) were infected while in the group treated with 8 injections ( 256 cases ) 25 ( 9.8 % ) were infected . The X2 was 0.25 and there is a lack of statistically significant difference between treatments . Duration of prophylactic antibiotic therapy  can be shortened , without loss of efficacy in thoracic or vascular aseptic surgery , to reduce selection of resistant germs and to lower costs Background Surgical site infections are the most common hospital-acquired infections among surgical patients . The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate . While most studies suggest that it should be given as close to the incision time as possible , others conclude that this may be too late for optimal prevention of surgical site infections . A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery . The aim of this article is to report the design and protocol of a r and omized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis . Methods / Design In this bi-center r and omized controlled trial conducted at two tertiary referral centers in Switzerl and , we plan to include 5,000 patients undergoing general , oncologic , vascular and orthopedic trauma procedures . Patients are r and omized in a 1:1 ratio into two groups : one receiving surgical antimicrobial prophylaxis in the anesthesia room ( 75 to 30 minutes before incision ) and the other receiving surgical antimicrobial prophylaxis in the operating room ( less than 30 minutes before incision ) . We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision . The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period ( one year with an implant in place ) . When assuming a 5 % surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room , the planned sample size has an 80 % power to detect a relative risk reduction for surgical site infections of 33 % when administering surgical antimicrobial prophylaxis in the anesthesia room ( with a two-sided type I error of 5 % ) . We expect the study to be completed within three years . Discussion The results of this r and omized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital . Moreover , the results of this r and omized controlled trial are of significant interest for patient safety and healthcare economics . Trial registration This trial is registered on Clinical Trials.gov under the identifier NCT01790529 BACKGROUND --Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation .  Antibiotic prophylaxis is commonly prescribed to reduce the incidence of this complication , but current trial evidence of its efficacy is conflicting . A large prospect i ve r and omised trial was therefore performed of antibiotic prophylaxis in permanent pacemaker implantation . The intention was firstly to determine whether antibiotic prophylaxis is efficacious in these patients and secondly to identify which patients are at the highest risk of infection . METHODS --A prospect i ve r and omised open trial of flucloxacillin ( clindamycin if the patient was allergic to penicillin ) v no antibiotic was performed in a cohort of patients undergoing first implantation of a permanent pacing system over a 17 month period .  Intravenous antibiotics were started at the time of implantation and continued for 48 hours . The trial endpoint was a repeat operation for an infective complication . RESULTS --473 patients were entered into a r and omised trial . 224 received antibiotic prophylaxis  and 249 received  no antibiotics . A further 183 patients were not r and omised but were treated according to the operator 's preference ( 64 antibiotics , 119 no antibiotics ) ; these patients are included only in the analysis of predictors of infection . Patients were followed up for a mean ( SD ) of 19(5 ) months . Among the patients in the r and omised group there were nine infections requiring a repeat operation , all in the group not receiving antibiotic ( P = 0.003 ) . In the total patient cohort there were 13 infections , all but one in the non-antibiotic group ( P = 0.006 ) . Nine of the infections presented as erosion of the pulse generator or electrode , three as septicaemia secondary to Staphylococcus aureus , and one as a pocket abscess secondary to Staphylococcus epidermidis . Infections were significantly more common when the operator was inexperienced ( < or = 100 previous patients ) , the operation was prolonged , or after a repeat operation for non-infective complications ( principally lead displacement ) . Infection was not significantly more common in patients identified preoperatively as being at high risk ( for example patients with diabetes mellitus , patients receiving long term steroid treatment ) , although there was a trend in this direction . CONCLUSIONS --Antibiotic prophylaxis significantly reduced the incidence of infective complications requiring a repeat operation after permanent pacemaker implantation . It is suggested that antibiotics should be used routinely Systematic review s and meta-analyses published in recent years have allowed drafting of evidence -based guidelines for antibiotic prophylaxis in orthopedic and trauma surgery . It is important to recognize the limitations of the recommendations derived from the available body of evidence . Since some of the most relevant r and omized controlled clinical trials were performed more than 20 years ago , it is sometimes difficult to apply the data to today 's clinical practice . In establishing consensus guidelines , it could prove difficult to identify areas for improvement through further research and better compliance . Although recommendations for optimized treatment of orthopedic implant infections are not currently based on first-class evidence , there are very promising new concepts emerging in this field , and we are awaiting more data and decisive conclusions from larger clinical trials 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
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 .