Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room. [Value of short prophylactic antibiotherapy in thoracic and vascular surgery. Comparative randomized double-blind study of 3 and 8 injections of cefamandole]. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Antibiotic Prophylaxis in High-Risk Head and Neck Surgery: One-Day vs. Five-Day Therapy Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery. Antibiotic prophylaxis for cardiac surgery in Australia. Cardiac surgery in a high-risk group of patients: is prolonged postoperative antibiotic prophylaxis effective? Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: a randomized controlled trial. Re-emphasis of priorities in surgical antibiotic prophylaxis. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. Cefotaxime prophylaxis in major non-contaminated head and neck surgery: one-day vs. seven-day therapy. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial Optimizing the timing of antimicrobial prophylaxis in surgery: an intervention study. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections: Results From the Trial to Reduce Antimicrobial Prophylaxis Errors Short-term versus long-term cefuroxime prophylaxis in patients undergoing emergency cesarean section. Changes in sample size and length of follow-up to maintain power in the coronary artery bypass graft (CABG) patch trial.
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 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 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 Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis . This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day . A multi-institutional prospect i ve r and omized double-blind study was design ed . Patients who were identified as requiring pedicled flap reconstruction were potential c and i date s for the study . Later , patients were r and omly assigned to receive cefoperazone sodium for either 24 hours or 120 hours . In each case , the drug was administered intravenously , beginning 1 to 2 hours preoperatively and continued for the prescribed period . One hundred nine patients were evaluable . Fifty-three patients were assigned to 1 day of perioperative prophylaxis .  Wound Infection developed in ten patients ( 18.9 % ) . Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis .  Wound infection developed in 14 ( 25 % ) of these patients ( P > .05 ) . These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction 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 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 PURPOSE Patients with pneumonia often remain hospitalized after they are stable clinical ly , and the duration of intravenous antibiotic therapy is a rate-limiting step for discharge . The purpose of this study was to determine whether implementation of an evidence -based guideline would reduce the duration of intravenous antibiotic therapy and length of stay for patients hospitalized with pneumonia . METHODS In a seven-site , cluster r and omized clinical trial , we enrolled 325 control and 283 intervention patients who were admitted by one of 116 physician groups . Within site , physician groups were assigned r and omly to receive a practice guideline alone ( control arm ) or a practice guideline that was implemented using a multifaceted strategy ( intervention arm ) . The effectiveness of guideline implementation was measured by the duration of intravenous antibiotic therapy and length of stay ; differences in the rates of discontinuation and hospital discharge were assessed with proportional hazards models . Medical outcomes were assessed at 30 days . RESULTS Intravenous antibiotic therapy was discontinued somewhat more quickly in the intervention group ( hazard ratio [ HR ] = 1.23 ; 95 % confidence interval [ CI ] : 1.00 to 1.52 ; P = 0.06 ) than in the control group . Intervention patients were discharged more quickly , but the difference was not statistically significant ( HR = 1.16 ; 95 % CI : 0.97 to 1.38 ; P = 0.11 ) . Fewer intervention ( 55 % [ 157/283 ] ) than control ( 63 % [ 206/325 ] ) patients had medical complications during the index hospitalization ( P = 0.04 ) , with no differences in other medical outcomes , including mortality , rehospitalization , and return to usual activities , between treatment arms . CONCLUSIONS The multifaceted guideline implementation strategy result ed in a slight reduction in the duration of intravenous antibiotic therapy and a nonsignificant reduction in length of stay , without affecting patient outcomes The results of two prospect i ve , r and omized trials , comparing single dose piperacillin with multidose cefoxitin prophylaxis in elective surgical procedures of the gastrointestinal tract were combined to examine some basic aspects of clinical ly , applied antibiotic prophylaxis . As there was no difference in the efficacy of prophylaxis between the groups , data from both centers and both drug groups were combined for analysis . Patients whose ages were greater than 40 years , the presence of cancer and the administration of an antibiotic for longer than 60 minutes preoperatively were associated with a higher rate of infectious complications . Duration of operation was also related to subsequent infection , ranging from 6 per cent in procedures lasting less than two hours to 27 per cent in operations lasting more than four hours . There was a greater failure of prophylaxis in patients undergoing rectal procedures , with a 29 per cent rate of infectious complications compared with 14 per cent in patients undergoing operations upon the colon . This difference was present even when duration of operation was taken into account 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 Patients who undergo major surgery of head and neck benefit from perioperative antibiotic prophylaxis . This study was developed to determine if seven days of antibiotic administration would be more effective than one day . A prospect i ve r and omized double blind study was design ed . Patients were r and omly assigned to receive cefotaxime sodium for either 24 hours or seven days . In each case , the drug was administered intramuscularly , beginning one to two hours pre-operatively and continued for the prescribed period . Sixty patients were included in the trial . Of 30 patients assigned to one day of perioperative prophylaxis , wound infection developed in four ( 13 per cent ) . Of 30 patients assigned to seven days of perioperative antibiotic prophylaxis , wound infection developed in three ( 10 per cent ) ( P > 0.05 ) . These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours post-operatively can be achieved in patients who undergo major head and neck surgery 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 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 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 Objective : The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis ( AMP ) . Summary Background Data : National AMP guidelines should be supported by evidence from large contemporary data sets . Methods : Twenty-nine hospitals prospect ively obtained information on AMP from 4472 r and omly selected cardiac , hip/knee arthroplasty , and hysterectomy cases .  Surgical site infections ( SSIs ) were ascertained through routine surveillance , using National Nosocomial Infections Surveillance system methodology . The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression ( conditioning on hospital ) . Results : One-hundred thirteen SSI were detected in 109 patients .  SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased ( overall association between timing and infection risk P = 0.04 ) . When antibiotics requiring long infusion times ( vancomycin and fluoroquinolones ) were excluded , the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6 % compared with 2.4 % associated with administration of antibiotic between 31 to 60 minutes prior to surgery ( OR : 1.74 ; 95 % confidence interval , 0.98–3.04 ) . The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision . Intraoperative redosing ( performed in only 21 % of long operations ) appeared to reduce SSI risk in operations lasting more than 4 hours ( OR of 3.08 with no redosing ; 95 % confidence interval 0.74–12.90 ) , but only when the preoperative dose was given correctly . Conclusions : These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision A prospect i ve r and omized clinical trial was conducted to test the effectiveness of long-term and short-term prophylaxis with cefuroxime in preventing morbidity after cesarean section .  Sixty patients who required emergency cesarean section were r and omly assigned to one of three treatment groups : a control group of 20 patients receiving no prophylactic antibiotics ; a group of 20 patients receiving 24 hours of cefuroxime prophylaxis ( 0.75 gm 30 to 60 minutes before surgery and at 8 hours and 16 hours after surgery ) ; and a group of 20 patients receiving five days of cefuroxime prophylaxis ( 0.75 gm three times a day , the first dose being given postoperatively ) . The short-term and long-term prophylaxes were equally effective in reducing morbidity , assessed by postoperative temperatures , presence or absence of endometritis , and duration of postoperative hospital stay The CABG Patch Trial is testing the hypothesis that prophylactic use of implantable cardiac defibrillators ( ICDs ) will improve survival in high-risk coronary heart disease patients undergoing CABG surgery . The original design called for 800 patients to be r and omized to ICD prophylaxis or to no therapy and followed for 2 to 6.5 years ( average , 40 months ) to a common termination date . Since the ICD pulse generators used in this trial lasted about 42 months , the original design required ICD replacement in many patients . At its first two meetings in 1993 , the Data and Safety Monitoring Board ( DSMB ) formalized a plan to adjust sample size in October 1994 if the control group mortality rate was lower than expected . In June 1994 , an unanticipated and unique event -- a subpoena from the Office of the Inspector General (OIG)--made it impossible to replace about half of the ICD generators and threatened to shorten follow-up substantially . If follow-up had been stopped on the date originally planned , but without replacing ICDs , the average follow-up would have fallen from 40 months to about 33 months . Also , in October 1994 , the control group mortality rate was found to be somewhat lower than expected . Together , the abbreviated follow-up and lower control group mortality threatened to reduce power substantially . The DSMB review ed several options for restoring power . Because mortality rates in the first month after CABG surgery were about seven times as high as thereafter and because ICD therapy did not reduce surgical mortality ( death during the first 30 days ) , extending the follow-up benefits power more than does increasing the sample size . However , the limit on extending follow-up was 42 months ( the expected battery life of the ICD ) . Data from the ICD-treated group was not review ed or considered in making the decision . After review ing many options for restoring power , the DSMB recommended that the sample size be increased from 800 to 900 patients and that almost all patients be followed for 42 months . This recommendation extended follow-up for 2 years beyond the original termination date planned for the trial and dictated that patients close out after 42 months rather than on a common termination date
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 .
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 .