Antibiotic prophylaxis for cardiac surgery in Australia

Area of Science:

• Infectious Diseases
• Surgical Care
• Pharmacology

Background:

• Antibiotic prophylaxis is crucial in cardiac surgery to prevent surgical site infections.
• National guidelines exist for optimal antibiotic use in this high-risk patient population.
• Variations in practice may impact patient outcomes and antimicrobial resistance.

Purpose of the Study:

• To assess national practices regarding antibiotic prophylaxis in Australian cardiac surgery.
• To evaluate the use of protocols, antibiotic agent selection, and administration duration.
• To identify trends and adherence to guidelines between 2004 and 2008.

Main Methods:

• Two point-prevalence surveys were conducted in Australian intensive care units performing cardiac surgery.
• Data were collected via structured telephone questionnaires from senior clinicians.
• Surveys in 2004 and 2008 captured information on protocol existence, agent choice, and duration of antibiotic administration.

Main Results:

• Reported protocol use for antibiotic prophylaxis in cardiac surgery increased from 58% to 80% (P=0.02).
• Concordance with national guidelines for agent choice and duration remained low at approximately 10%.
• The use of vancomycin for routine valve surgery prophylaxis doubled to 62% (P<0.001).

Conclusions:

• Despite increased protocol adoption, adherence to national antibiotic prophylaxis guidelines in cardiac surgery is low.
• Duration of antibiotic administration frequently deviates from recommendations.
• Further evidence from randomized trials or surveillance is needed to improve clinical implementation of guidelines.