title: Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study.
abstract: BACKGROUND
  All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial.
  
  
  METHODS
  Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients' characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate.
  
  
  RESULTS
  615/1096 patients (56,1%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4%), 5/283 (1,7%), and 1/283 (0,3%) in group I versus 6/332 (1,8%), 9/332 (2,7%), and 3/332 (0,9%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05).
  
  
  CONCLUSIONS
  Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs.
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Hamouda_k@ukw.de.
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamouda
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Oezkur_m@ukw.de.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oezkur
authors.affiliation: Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands. b.sinha@umcg.nl.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
authors.affiliation: University of Würzburg, Institute of Mathematics and Informatics, Chair of Mathematics VIII (Statistics), Würzburg, Germany. johannes.hain@uni-wuerzburg.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hain
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Menkel_h@ukw.de.
authors.forename: Hannah
authors.initials: H
authors.lastname: Menkel
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Leistner_m@ukw.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Leistner
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Leyh_r@ukw.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Leyh
authors.affiliation: Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany. Schimmer_c@klinik.uni-wuerzburg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schimmer
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002511:Cephalosporins / Q000008:administration & dosage; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins