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Tolerance of vancomycin for surgical prophylaxis in patients undergoing cardiac surgery and incidence of
Sumesh Kachroo1, Thanh Dao, Firas Zabaneh
1Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, TX 77030, USA.
Background:
In 2001, vancomycin replaced cefuroxime for antibiotic prophylaxis in patients undergoing cardiac surgery at our institution due to high rates of surgical site infections caused by methicillin-resistant Staphylococcus spp. However, few data supported the use of vancomycin for surgical prophylaxis.
Objective:
To determine the tolerance of vancomycin for antibiotic prophylaxis and incidence of vancomycin-resistant Enterococcus (VRE) in cardiac surgery patients.
Methods:
In 2 separate studies, we assessed the adverse effects in patients given perioperative vancomycin (study 1) and the incidence of VRE in patients given perioperative vancomycin (study 2). Study 1 was a prospective cohort study of patients undergoing coronary artery bypass graft (CABG) or valve replacement surgery given vancomycin (1 dose preoperatively/2 doses postoperatively) for antibiotic prophylaxis between October 2003 and December 2004. Patients were assessed for tolerance to the antibiotic regimen. In study 2, cardiac surgery patients receiving perioperative vancomycin were screened for VRE before therapy and at day 7 of hospitalization. VRE was detected using standard microbiologic procedures.
Results:
In study 1, 1161 patients (CABG = 75%; valve = 19%; both = 6%) were evaluated. All patients but one (99.9%) were prescribed preoperative vancomycin. Therapy was changed for 34 (2.9%) patients, of which 20 changes were due to physician preference for another antibiotic. The only toxicity that required a change in the vancomycin regimen was red man's syndrome, which was experienced by 9 (0.8%) patients. Four patients did not receive a second postoperative dose due to prior renal insufficiency. Patients were most commonly switched to cefuroxime (n = 26), linezolid (n = 2), cefepime (n = 2), gatifloxacin, cefazolin, levofloxacin, or ceftriaxone (n = 1, each). In study 2, 100 patients were screened for the emergence of VRE colonization. No patient was VRE positive at baseline and 4 (4%) were positive at day 7.
Conclusions:
Surgical antibiotic prophylaxis with vancomycin was reasonably well tolerated in CABG and valve replacement surgery, with a 4% incidence of VRE colonization.
Insights
Vancomycin is well-tolerated for cardiac surgery prophylaxis, with a 4% incidence of vancomycin-resistant Enterococcus (VRE) colonization. This study evaluated its safety and efficacy in preventing surgical site infections.
Area of Science:
- Infectious Diseases
- Cardiovascular Surgery
- Pharmacology
Background:
- Vancomycin replaced cefuroxime for cardiac surgery prophylaxis in 2001 due to high rates of methicillin-resistant Staphylococcus surgical site infections.
- Limited data previously supported vancomycin use for surgical prophylaxis.
Purpose of the Study:
- To assess the tolerance of vancomycin as antibiotic prophylaxis in cardiac surgery patients.
- To determine the incidence of vancomycin-resistant Enterococcus (VRE) in this patient population.
Main Methods:
- Two prospective studies were conducted: Study 1 assessed adverse effects of perioperative vancomycin in 1161 coronary artery bypass graft (CABG) or valve replacement patients.
- Study 2 screened 100 cardiac surgery patients receiving vancomycin for VRE colonization at baseline and day 7.
Main Results:
- Vancomycin was well-tolerated, with only 0.8% experiencing red man's syndrome; 2.9% had therapy changes, often for physician preference.
- Four percent (4%) of patients screened in Study 2 developed VRE colonization by day 7.
Conclusions:
- Perioperative vancomycin demonstrates reasonable tolerance in CABG and valve replacement surgery.
- A 4% incidence of VRE colonization was observed, warranting continued surveillance.
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