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Antibiotic prophylaxis in cardiac operations
J C Hall1, K Christiansen, M J Carter
1Division of Surgery, Royal Perth Hospital, Australia.
Abstract:
This clinical trial, which was composed of 1,031 adults undergoing cardiac operations, compared the efficacy of a single dose of 1 g of ceftriaxone with a 48-our regimen consisting of flucloxacillin and gentamicin. There was no significant difference (p = 0.89) in the overall incidence of major infections: 30 of 515 patients (5.8%; 95% confidence interval, 5.4% to 6.2%) taking ceftriaxone and 29 of 516 patients (5.6%; 95% confidence interval, 5.2% to 6.0%) taking flucloxacillin and gentamicin. Subgroup analyses, with a lower statistical power, failed to show a significant difference between patients who received ceftriaxone and those who received flucloxacillin/gentamicin: major sternal wound infections arose in 2.7% of the patients taking ceftriaxone versus 1.6% in those on the 48-hour regimen (p = 0.20) and major limb wound infections arose in 4.2% and 5.4%, respectively (p = 0.44). Single-dose prophylaxis was associated with fewer intravenous administrations (864 doses versus 9,570 doses) and cost less (A$17,248 versus A$78,510). Although the regimen that included gentamicin was associated with the greatest biochemical impairment of renal function, the overall toxicity for both groups was low. We conclude that a single dose of ceftriaxone provided cost-efficient prophylaxis for adults undergoing cardiac operations when compared with a 48-hour regimen of gentamicin and flucloxacillin. The general principle revealed by our data is that the short-term administration of an appropriate antibiotic regimen represents optimal prophylaxis for patients undergoing cardiac procedures.
Insights
A single dose of ceftriaxone is as effective as a 48-hour antibiotic regimen for cardiac surgery prophylaxis. This approach is more cost-efficient and reduces intravenous administrations.
Area of Science:
- Infectious Diseases
- Surgical Prophylaxis
- Pharmacoeconomics
Background:
- Antibiotic prophylaxis is crucial in preventing surgical site infections following cardiac operations.
- Traditional prophylaxis regimens can involve prolonged administration and higher costs.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of single-dose ceftriaxone versus a 48-hour flucloxacillin/gentamicin regimen for antibiotic prophylaxis in adult cardiac surgery.
- To evaluate infection rates, administration burden, and toxicity profiles of the two regimens.
Main Methods:
- A clinical trial involving 1,031 adult patients undergoing cardiac operations.
- Comparison of infection incidence between patients receiving single-dose ceftriaxone and those receiving a 48-hour flucloxacillin/gentamicin regimen.
Main Results:
- No significant difference in overall major infection rates (5.8% vs. 5.6%, p=0.89).
- Single-dose ceftriaxone significantly reduced intravenous administrations (864 vs. 9,570 doses) and costs (A$17,248 vs. A$78,510).
- Gentamicin-containing regimen showed greater renal impairment, though overall toxicity was low.
Conclusions:
- Single-dose ceftriaxone is a cost-efficient and effective prophylactic strategy for adult cardiac surgery.
- Short-term antibiotic administration is optimal for prophylaxis in cardiac procedures.