title: Adjuvant vancomycin for antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  The incidence of hospital-acquired Clostridium difficile infection (CDI) has increased rapidly over the past decade; patients undergoing major surgery, including coronary artery bypass grafting (CABG), are at particular risk. Intravenous vancomycin exposure has been identified as an independent risk factor for CDI, but this is controversial. It is not known whether vancomycin administered for surgical site infection prophylaxis increases the risk of CDI.
  
  
  METHODS
  Using data from the Premier Perspective Comparative Database, we assembled a cohort of 69,807 patients undergoing CABG surgery between 2004 and 2010 who received either a cephalosporin alone (65.1%) or a cephalosporin plus vancomycin (34.9%) on the day of surgery. Patients were observed for CDI until discharge from the index hospitalization. In these groups, we evaluated the comparative rate of postoperative CDI with Cox models; confounding was addressed using propensity scores.
  
  
  RESULTS
  In all, 77 (0.32%) of the 24,393 patients receiving a cephalosporin plus vancomycin and 179 (0.39%) of the 45,414 patients receiving a cephalosporin alone had postoperative CDI (unadjusted hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.56-0.95). After adjusting for confounding variables with either propensity score matching or stratification, there was no meaningful association between adjuvant vancomycin exposure and postoperative CDI (HR, 0.85; 95% CI, 0.61-1.19; and HR, 0.85; 95% CI, 0.63-1.15, respectively). Results of multiple sensitivity analyses were similar to the main findings.
  
  
  CONCLUSIONS
  After adjustment for patient and surgical characteristics, a short course of prophylactic vancomycin was not associated with an increased risk of CDI among patients undergoing CABG surgery.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA. BBateman@partners.org
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Rassen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Bykov
authors.forename: Jessica Myers
authors.initials: JM
authors.lastname: Franklin
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Gagne
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Polinski
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods*; D002511:Cephalosporins / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin
keywords: 23.1; 40.4; 41.1; CABG; CDI; CI; Clostridium difficile infection; HR; SSI; confidence interval; coronary artery bypass grafting; hazard ratio; surgical site infection
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