Impact of standardization of antimicrobial prophylaxis duration in pediatric cardiac surgery

Bath, Sundeep; Lines, Jason; Loeffler, Ann M.; Malhotra, Ashim; Turner, R. Brigg

doi:10.1016/j.jtcvs.2016.04.091

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…Postoperative infections were defined by each author. Most studies 3,6 -9,17 -24 used the National Health Safety Network/Centers for Disease Control and Prevention (NHSN/CDC) guidelines, 25 and one study 26 referenced the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) definitions. 11 Studies using the NHSN/CDC definitions referenced the 1988 guidelines, 2008 guidelines, or did not specify which guidelines were used.…”

Section: Methodsmentioning

confidence: 99%

“…[3][4][5][6][7] Despite its wide adoption for the perceived hemodynamic benefit, DSC is associated with higher rates of postoperative infections in single-and multi-institutional studies compared to primary sternal closure. 3,[7][8][9][10][11][12][13] These infections are costly in terms of both resources and patient outcomes, as postoperative infections are associated with longer hospitalizations, higher healthcare costs, and increased early mortality. 14,15 In one study, postoperative infections were identified as the leading cause of mortality in patients following DSC.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

Kennedy

DiLeonardo

Hurtado

et al. 2020

World J Pediatr Congenit Heart Surg

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Antibiotic prophylaxis following delayed sternal closure in pediatric cardiac surgery is not standardized. We systematically reviewed relevant literature published between 1990 and 2019 to aid future trial design. Patient characteristics, antimicrobial prophylaxis regimens, and postoperative incidence of infection were collected. Twenty-eight studies described 36 different regimens in over 3,000 patients. There were 11 single-drug regimens and 25 multidrug regimens. Cefazolin-only was the most common regimen (9/36, 25%). The overall incidence of surgical site infection was 7.5% (217/2,910 patients) and bloodstream infection was 7.4% (123/1,667 patients). In the 2010s, multidrug regimens were associated with a significantly lower incidence of both surgical site infections (4.6% vs. 20%, P < .001) and bloodstream infections (6.0% vs. 50%, P < .001) compared to single-drug regimens.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

Kennedy

DiLeonardo

Hurtado

et al. 2020

World J Pediatr Congenit Heart Surg

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“…After a careful search for references, we identified an additional 8 of 48 papers relevant for the analysis. After the removal of duplicates, exclusion of reports other than original papers or reviews, and reports that did not fulfill the inclusion criteria, we identified 20 publications for the final analysis [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Detailed information included in these 20 papers is provided in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In our review, most of the centers discontinue antibiotic prophylaxis before 24-48 hours. Many authors conclude that suspension of antimicrobial prophylaxis during the first 48 hours after surgery did not increase the rate of nosocomial infections [1,19]. It should be mentioned that there are studies showing that the incidence of infections was significantly higher in patients in whom prophylaxis was maintained postoperatively for more than 48 hours than in the others (16.2% vs. 6.7%; p < 0.05) [1].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

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Background: Prophylactic antibiotic therapy is given routinely in the peri-operative period to prevent surgical site infection. However, in pediatric cardiac surgery, an optimal schedule has not been defined. Pediatric recommendations follow the guidelines for adults, which might be improper because of the inherent challenges in pediatric research and the heterogeneity of the population. Implementation of an effective prophylaxis protocol is needed for children undergoing cardiac surgery, especially in view of worldwide antibiotic overuse and the development of drug resistance. In this review, we analyze the current knowledge supported by up-todate publications about antibiotic prophylaxis in pediatric cardiac surgery. Methods: The PubMed Ò database was searched for full-text journal articles describing peri-operative antibiotic prophylaxis in pediatric cardiac surgery published since 2000. Antibiotics used for standard prophylaxis with dosing schema, time of the first dose, additional dosage in extracorporeal circulation (ECC) priming, and prophylaxis duration were analyzed. Additionally, we looked for special clinical situations such as antibiotic prophylaxis in children with the sternum left open after surgery and patients with b-lactam allergy or preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization or those requiring extracorporeal membrane oxygenation (ECMO). Results: A total of 1,546 articles were evaluated, and we identified 20 for further analysis. On the basis of the current peri-operative antibiotic prophylaxis recommendations for cardiac surgery and the papers reviewed, we tried to propose a schedule for peri-operative antibiotic prophylaxis in pediatric cardiac surgery. Conclusions: There is a need for careful use and examination of the schedule proposed because the pharmacokinetics of antibiotics in pediatric patients with ECC is not fully understood. This should be evaluated further. Formulating uniform recommendations concerning peri-operative antibiotic prophylaxis is difficult.

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“…Control blood glucose during the immediate postoperative period for cardiac surgery patients. Preoperatively, use chlorhexidine gluconate 2% and isopropyl alcohol solution as skin antiseptic preparation, and allow appropriate drying time per product guidelines [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

Surgical Site Infections

Nathens¹,

Dellinger²

2019

AIDT

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Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day postdischarge SSI as per CDC definitions of SSI should be consider in order to have a valid data inside the hospital Surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US$ 10 billion per year., An SSI develops in 2% to 5% of patients undergoing surgical procedures each year in the United States which mean 500,000 and 750,000 SSIs occur annually, Institute of Healthcare Improvement has estimated that 40-60% of all SSIs are preventable. Mean attributable costs for SSI were $25,546 in a recent analysis of published studies on SSI costs, however, among the many measures to prevent SSI, only some are based on strong evidence we need to provide best practice recommendations for SSI management and prevention in hospitals and community care.

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Impact of standardization of antimicrobial prophylaxis duration in pediatric cardiac surgery

Cited by 15 publications

References 28 publications

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Surgical Site Infections

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