Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

Abstract

Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.

Assessment of the impact of intravenous antibiotics treatment on gut microbiota in patients: Clinical data from pre-and post-cardiac surgery

“…Clinical practice guidelines for antibiotic prophylaxis provide some recommendations in cardiac surgery (Hamouda et al, 2015;Eckardt et al, 2018). Periprocedural antibiotics are necessary to prevent infection post-cardiac surgery (Gudbjartsson et al, 2016;Schimmer et al, 2017;Kachel et al, 2020;Surat et al, 2021).…”

The Impact of Patient-Reported Penicillin or Cephalosporin Allergy on the Occurrence of the Periprosthetic Joint Infection in Primary Knee and Hip Arthroplasty

“…Based on the similar coverage spectra of cefazolin and cefuroxime, as well as similar PJI rates between the studies, it is unlikely that different choice of first-line prophylactic antibiotic could significantly influence the results of the present study. There are many studies comparing different first-line prophylactic antibiotics—cefuroxime, cefazolin and cloxacillin—in vascular and neurosurgery [ 30 , 31 ]; however, the current literature on this topic in the orthopedic field remains scarce.…”

Introduction to Antibiotic Stewardship Principles for the Perioperative Nurse

“…4,27 The CDC recommends compliance with the four "rights" of antibiotic prescribing: "the right antibiotic, at the right dose, for the right duration, and at the right time." 28 Using the four rights framework, perioperative antibiotic prescribing has focused on the areas of antibiotic selection 6,[29][30][31] and duration 32,33 of a planned procedure as well as the timing of antibiotic administration during the perioperative period to minimize SSIs. 34,35 A review of the literature regarding perioperative antibiotic decision making and prescribing for every category of surgical procedure is beyond the scope of this article.…”