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. 2023 Jan 4;12(1):85.
doi: 10.3390/antibiotics12010085.

Impact of Antibiotic Prophylaxis on Surgical Site Infections in Cardiac Surgery

Christian de Tymowski  1   2   3   4 , Tarek Sahnoun  1 , Sophie Provenchere  1   5 , Marylou Para  6   7 , Nicolas Derre  1 , Pierre Mutuon  8 , Xavier Duval  5   7   9 , Nathalie Grall  9   10 , Bernard Iung  7   11 , Solen Kernéis  7   9   12 , Jean-Christophe Lucet  7   9   12 , Philippe Montravers  1   7   13
Affiliations

Impact of Antibiotic Prophylaxis on Surgical Site Infections in Cardiac Surgery

Christian de Tymowski et al. Antibiotics (Basel). .

Abstract

(1) Background: Cephalosporins (CA) are the first-line antibiotic prophylaxis recommended to prevent surgical site infection (SSI) after cardiac surgery. The combination of vancomycin/gentamicin (VGA) might represent a good alternative, but few studies have evaluated its efficacy in SSI prevention. (2) Methods: A single-centre retrospective study was conducted over a 13-year period in all consecutive adult patients undergoing elective cardiac surgery. Patients were stratified according to the type of antibiotic prophylaxis. CA served as the first-line prophylaxis, and VGA was used as the second-line prophylaxis. The primary endpoint was SSI occurrence at 90 days, which was defined as the need for reoperation due to SSI. (3) Results: In total, 14,960 adult patients treated consecutively from 2006 to 2019 were included in this study, of whom 1774 (12%) received VGA and 540 (3.7%) developed SSI. VGA patients had higher severity with increased 90-day mortality. Nevertheless, the frequency of SSI was similar between CA and VGA patients. However, the microbiological aetiologies were different, with more Gram-negative bacteria noted in the VGA group. (4) Conclusions: VGA seems to be as effective as CA in preventing SSI.

Keywords: antibiotic prophylaxis; cardiac surgery; cardiopulmonary bypass; cephalosporins; gentamicin; surgical site infection; vancomycin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study. INSEE: Institut National de la Statistique et des Etudes Economiques; SSI, surgical site infection. dSSI, deep SSI; sSSI: superficial SSI.
Figure 2
Figure 2
SSI-free patients at 90 days and delay of SSI occurrence according to the type of prophylaxis. CA, cephalosporin antibiotic prophylaxis; VGA, vancomycin/gentamicin antibiotic prophylaxis; SSI, surgical site infection.
Figure 3
Figure 3
sSSI-free and dSSI-free patients at 90 days and delay of SSI occurrence according to the type of prophylaxis. (A) Superficial SSI; (B) Deep SSI. CA: cephalosporin antibiotic prophylaxis, VGA vancomycin/gentamicin antibiotic prophylaxis. SSI, surgical site infection.
Figure 4
Figure 4
SSI-free patients at 90 days and delay of SSI occurrence according to the type of prophylaxis in the sensitivity analysis, excluding infective active endocarditis. (A) All SSI, (B) Superficial SSI; (C) Deep SSI. CA, cephalosporin antibiotic prophylaxis; VGA, vancomycin/gentamicin antibiotic prophylaxis; SSI, surgical site infection.
Figure 5
Figure 5
SSI-free patients at 90 days and delay of SSI occurrence according to the type of prophylaxis in the sensitivity analysis restricted to CABG. (A) All SSI, (B) Superficial SSI; (C) Deep SSI. CA, cephalosporin antibiotic prophylaxis; CABG, coronary artery bypass graft, VGA, vancomycin/gentamicin antibiotic prophylaxis; SSI, surgical site infection.
See this image and copyright information in PMC

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