Thorac Cardiovasc Surg 2015; 63 - ePP9
DOI: 10.1055/s-0035-1544505

Choice and Duration of Antibiotic Prophylaxis in Adult Cardiac Surgery

C. Schimmer 1, K. Hamouda 1, M. Oezkur 1, S. P. Sommer 1, M. Leistner 1, R. Leyh 1
  • 1Klinik und Poliklinik für Herz- und Thoraxchirurgie, Würzburg, Germany

Objectives: The principles of antibiotic prophylaxis are based on (1) the choice of the antimicrobial agent; (2) the timing of the first administered dose, and (3) the duration of the prophylactic regimen. Prophylactic intravenous antibiotics should be routinely administered to patients undergoing cardiac surgery. However, the optimal choice, dosing and frequency of periopeative antibiotic prophylaxis in cardiac surgery is controversial.

Methods: A nationwide questionnaire was distributed to all German heart surgery centers concerning the choice and the duration of antibiotic prophylaxis in adult cardiac surgery. Furthermore, we present a summarize of the different guidelines of antibiotic prophylaxis in cardiac surgery.

Results: We were able to achieve answers from 69/79 (87.3%) German surgical heart centers (either they completed the questionnaire or we get the answers by telephone or e-mail). 10 clinics denied answering the questionnaire. Strictly, 100% of all German heart centers use an antibiotic prophylaxis. 23% use a single-shot prophylaxis and 79% of all German heart centers use the routine perioperative antibiotic prophylaxis not longer than 24 hours (2x: 29%, 3x: 27%, 4x: 13%, and > 5x: 8%). 61/69 (89%) heart centers stated, that they use a cephalosporin (46% a second-generation cephalosporin: cefuroxim and 43% a first-generation cephalosporin: cefazolin). 2/69 (2%) clinics use ampicillin as the prophylactic antibiotics. Table 1 shows in summary the different international guidelines regarding the antibiotic prophylaxis for cardiac surgery patients.

Table 1

Society

Antibiotic choice

Duration

[Guidelines for antibiotic prophylaxis].

The Society of Thoracic Surgeons

First-generation cephalosporin

There is evidence indicating that antibiotic prophylaxis of 48 hours duration is effective. There is no evidence that prophylaxis administered for longer than 48 hours is more effective than a 48-hour regimen.

Paul-Ehrlich-Gesellschaft e.V.

First or second- generation cephalosporin

The duration is based on consensus of the expert panel because the data do not delineate the optimal duration of prophylaxis. Prophylaxis for 24 hours or less may be appropriate for cardiothoracic procedures.

American Heart Associaction

Cephalosporin

Data suggest that a 1-day course of intravenous antimicrobials is as efficacious as the traditional 48-hour (or longer) regimen.

American Society of Health-System Pharmacists Commission on Therapeutics

Cephalosporin

Prophylaxis for 24 hours or less may be appropriate for cardiothoracic procedures.

In case of allergy to penicillin 32% use clindamycin, 9% vancomycin, and 7% erythromycin. Standardized screening of Methicillin-resistant Staphylococcus aureus (MRSA) is arranged in 56/69 (82%) German surgical heart centers, decolonization procedures in all patients in 8/69 (12%), and only in MRSA positive patients in 54/69 (79%).

Conclusions: This survey showed that existing national guideline and recommendation concerning Choice and duration of antibiotic prophylaxis in adult cardiac surgery patients are well applied in almost all German heart centers.