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. 2021 Mar;22(2):83-90.
doi: 10.1177/1757177420971850. Epub 2020 Nov 24.

Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

James Kofi Ackah  1 , Louise Neal  1 , Neil R Marshall  2 , Pedram Panahi  1 , Clinton Lloyd  1 , Luke J Rogers  1
Affiliations

Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

James Kofi Ackah et al. J Infect Prev. 2021 Mar.

Abstract

Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection significantly. In 2018, the European Association for CardioThoracic Surgery (EACTS) provided clear guidance advising that third-generation cephalosporins are the first-line prophylactic antimicrobial of choice for cardiac surgery via median sternotomy as a result of their broad spectrum of activity and association with reduced postoperative mortality. Despite this guidance, it was believed that UK practice differed from this as a consequence of national concerns surrounding cephalosporins use and Clostridioides difficile infection.

Methods: A survey was developed and distributed to all UK and Republic of Ireland (ROI) cardiac surgery centres in January 2019 to quantify this variation.

Results: Of the 38 centres, 34 responded. Variation existed between the antimicrobial agent used, as well as the dosage, frequency and duration of suggested regimens even among centres using the same antimicrobial agent. The most common antimicrobial prophylaxis prescribed was a combination of flucloxacillin and gentamicin (16, 47%). Followed by cefuroxime (6, 17.6%) and cefuroxime combined with a glycopeptide (4, 11.7%). In patients colonised with methicillin-resistant Staphylococcus aureus or those with penicillin allergy gentamicin combined with teicoplanin was most common (42% and 50%, respectively).

Discussion: This variation in antimicrobial agents and regimens may well contribute to the varying incidence of surgical site infection seen across the UK and ROI.

Keywords: Cardiac surgery; Clostridioides difficile; Clostridium difficile; adult; antimicrobial prophylaxis; cephalosporins; deep sternal wound infection; infection prevention; surgical site infection.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Illustration of cardiac antimicrobial prophylaxis at 34 Trusts across the UK and ROI. Area relative to use of antimicrobial agent, with overlap indicating combined regimes. *Flucloxacillin use in a single centre is not a proportional representation.
Figure 2.
Figure 2.
Illustration of different dosing regimens used in adult cardiac antimicrobial prophylaxis.
See this image and copyright information in PMC

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