Antibiotic prophylaxis in cardiothoracic surgery: results of a second survey

The use of prophylactic antimicrobials in cardiothoracic surgery has become an accepted medical practice. The choice of drug and the duration of therapy varies among institutions. In 1985, we conducted a telephone survey to determine the choice of prophylactic antimicrobials in cardiothoracic surgery programs across the U.S. We recently conducted this survey for a second time. In our 1988 survey, 51 hospitals responded, with 34 (67%) having a standard antimicrobial regimen. Of all hospitals surveyed, first-generation cephalosporins were the most commonly used agents. First-generation cephalosporins were employed in 33 (48.4%) hospitals, cefamandole in 13 (19.1%), cefuroxime in nine (13.2%), vancomycin in three (4.4%), and vancomycin plus gentamicin in two (2.9%). A variety of other agents were employed by one of the remaining hospitals. Fourteen (27%) hospitals had automatic stop orders for antimicrobial prophylaxis in this indication. Ten (19.6%) institutions had changed the antimicrobial agent(s) used for prophylaxis in the last year. The results of this survey indicate that most hospitals continue to use first-generation cephalosporins for antimicrobial prophylaxis in cardiothoracic surgery, but there is considerable variation among institutions.