title: Effect of preoperative antibiotic prophylaxis on surgical site infections complicating cardiac surgery.
abstract: OBJECTIVE
  To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary medical center in Israel.
  
  
  METHODS
  SSIs were recorded during a 10-year study period and ascertained through routine surveillance using the National Healthcare Safety Network (NHSN) methodology. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes.
  
  
  RESULTS
  A total of 2,637 of 3,170 evaluated patients were included, and the overall SSI rate was 8.4%. A greater than 50% reduction in SSI rates was observed in the last 4 years of the study. Overall and site-specific infection rates were similar for patients receiving cefazolin or vancomycin. SSIs developed in 206 (8.1%) of the 2,536 patients who received preoperative prophylaxis (within 2 hours of the first incision) compared with 14 (13.9%) of 101 patients who received antibiotic prophylaxis at a different time (P = .04; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.3). After accounting for covariates, preoperative hospital stay (5 days or more), an NHSN risk category (2 or 3), age (60 years or more), surgeon's role, and the period of measurement were significantly associated with SSIs. Emergency surgery, age, surgeon's role, and nonpreoperative prophylaxis were found to be independent predictors of superficial SSI.
  
  
  CONCLUSIONS
  We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative prophylaxis in cardiac surgery.
authors: Infectious Diseases Unit, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Renato
authors: R
authors: Finkelstein
authors: Galit
authors: G
authors: Rabino
authors: Tania
authors: T
authors: Mashiach
authors: Yaron
authors: Y
authors: Bar-El
authors: Zvi
authors: Z
authors: Adler
authors: Victor
authors: V
authors: Kertzman
authors: Oved
authors: O
authors: Cohen
authors: Simcha
authors: S
authors: Milo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use*; D004630:Emergencies; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013903:Thoracic Surgery; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002437:Cefazolin