title: Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery.
abstract: OBJECTIVE
  To examine the efficacy of a protocol for the prophylactic use of antimicrobials in pediatric cardiac surgery.
  
  
  METHODS
  Nonrandomized comparison of two groups of patients studied sequentially.
  
  
  METHODS
  Pediatric intensive care unit of university hospital.
  
  
  METHODS
  Infants and children <18 yrs of age who had undergone cardiac surgery.
  
  
  METHODS
  Limitation of prophylactic antimicrobials to <48 hrs after operation and, in patients at high risk of methicillin-resistant Staphylococcus aureus, strong recommendation to use glycopeptides.
  
  
  RESULTS
  No intervention was applied in 189 patients (control group) during the first 21 months, whereas the intervention was applied in 185 patients (intervention group) during the next 18 months. In the intervention group, prophylaxis was recommended to be discontinued <48 hrs postoperatively. As a result, antimicrobials were administered for a median of 4 days (range 2-14) in the intervention group, significantly shorter than 7 days (3-35) in controls. This was associated with a trend toward a lower frequency of postoperative infections, including at the surgical site, and with significantly lower costs of antimicrobial therapy and a significantly lower rate of newly acquired nasal colonization with antibiotic-resistant pathogens in the intervention group (8%) than in controls (17%).Since, in the intervention group, glycopeptides were strongly recommended for patients at high risk of methicillin-resistant S. aureus, the frequency of surgical-site infections (0% vs. 18%) and the frequency of all infections (11% vs. 39%) were significantly lower in the intervention group than in the control group.
  
  
  CONCLUSIONS
  Limiting the duration of prophylactic antimicrobials was cost-effective and reduced the risk of acquiring resistant pathogens without increasing the frequency of postoperative infections. The use of glycopeptides in properly selected patients at high risk of methicillin-resistant S. aureus infection can lower the risk of postoperative infections.
authors.affiliation: Department of Anesthesiology and Intensive Care, Kyoto Prefectural University, School of Medicine, Kyoto, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kato
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shime
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Mayuko
authors.initials: M
authors.lastname: Nomura
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okayama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Naohisa
authors.initials: N
authors.lastname: Fujita
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control*; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D016106:Methicillin Resistance; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000517:prevention & control*; D017334:Teicoplanin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D017334:Teicoplanin; D014640:Vancomycin