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Interrupted time series analysis of vancomycin compared to cefuroxime for surgical prophylaxis in patients undergoing

K W Garey1, D Lai, T K Dao-Tran

  • 1University of Houston, College of Pharmacy, Texas Medical Center, 1441 Moursund Street, Houston, TX 77030, USA. kgarey@uh.edu

Antimicrobial Agents and Chemotherapy
|November 21, 2007
PubMed

Insights

Switching to vancomycin for surgical prophylaxis in coronary artery bypass graft (CABG) surgery reduced surgical site infections (SSIs). This change effectively lowered MRSA infections, demonstrating vancomycin

Area of Science:

  • Infectious Diseases
  • Surgical Outcomes
  • Antimicrobial Stewardship

Background:

  • Rising rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis necessitate alternative prophylactic antibiotics.
  • Vancomycin use for surgical prophylaxis is debated, requiring further clinical evidence, especially for high-risk procedures like coronary artery bypass graft (CABG) surgery.

Purpose of the Study:

  • To evaluate the impact of switching antibiotic prophylaxis from cefuroxime to vancomycin on surgical site infection (SSI) rates in CABG patients.
  • To assess the efficacy of vancomycin in preventing SSIs in the context of increasing MRSA prevalence.

Main Methods:

  • An interrupted time series analysis was employed to compare monthly SSI rates before and after the antibiotic prophylaxis change.
  • Data from 2001-2005 encompassing 4,239 CABG patients and 2,226 cardiac valve replacement patients were analyzed.
  • Cardiac valve replacement patients receiving vancomycin throughout served as a comparator group.

Main Results:

  • A statistically significant decrease of 2.1 SSIs per 100 CABG surgeries was observed after the switch to vancomycin (P = 0.042).
  • The reduction in SSIs was primarily attributed to a decrease in infections caused by coagulase-negative Staphylococcus and MRSA.
  • No significant changes in SSIs caused by other gram-positive or gram-negative organisms were noted.

Conclusions:

  • The transition to vancomycin prophylaxis for CABG surgery is clinically effective in reducing postoperative SSIs, particularly those caused by MRSA.
  • This evidence supports the use of vancomycin in institutions facing high incidences of methicillin-resistant Staphylococcus species to prevent SSIs in CABG patients.

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