[Antibiotic prophylaxis in cardiac surgery in France]

Prophylactic administration of antibiotics in patients undergoing cardiac surgery is now an established procedure. The interest of a short prophylaxis (less then 48 h), directed mainly against Gram positive cocci has been demonstrated. However, there is no general agreement as to the agent to be used. We thus conducted a survey of the current practice of antibiotic prophylaxis (ABP) by sending a detailed questionnaire to each of the 51 centers performing cardiac surgery in France. 48 replies (94%) were received. Monotherapy was used in 42 centers, with cephalosporins in 41 (cefamandole: 22, cefazolin: 10, cefuroxime: 4, cephalothin: 3, cefotiam: 2) and with minocycline in one center. Six centers used a combination including aminoglycoside. Mean duration of ABP was 1.8 +/- 1.2 d. First dose of antibiotic was given before cardiopulmonary (C-P) bypass intravenously. In 29 centers, AB was injected into the C-P pump. Mean dosage of cephalosporin before surgery was 25 mg/kg and total dosage was 70 mg/kg/24 h. We conclude that cephalosporins are almost exclusively chosen in France contrasting with other european countries such as the United Kingdom where the most used regimen is a combination of penicillinase-resistant penicillin and an aminoglycoside.