Sarah Berman, PharmD
PGY2 Critical Care Pharmacy Resident
University Health System
San Antonio, Texas
Disclosure information not submitted.
Hilary Raidt, PharmD, BCCCP
Clinical Pharmacy Specialist
The Christ Hospital, Ohio, United States
Disclosure information not submitted.
Abby Rhoades, BCCCP, PharmD
Clinical Pharmacy Specialist
The Christ Hospital, Ohio, United States
Disclosure information not submitted.
Angela Haskell, BCPS, PharmD
Clinical Pharmacy Specialist
The Christ Hospital, United States
Disclosure information not submitted.
Title: Impact of Dual Antibiotic Prophylaxis on Sternal Wound Infections in Cardiac Surgery Patients
Introduction:
Sternal wound infections (SWI) are a prominent concern after cardiac surgery due to associated morbidity and mortality. Recent observational studies have evaluated the use of vancomycin with a cephalosporin as surgical prophylaxis to broaden coverage against resistant organisms, with varying results. This study investigated the effect of vancomycin and a cephalosporin compared to a cephalosporin alone on overall incidence of SWI after cardiac surgery.
Methods: This single-center retrospective cohort study included all patients who underwent cardiac surgery requiring preoperative antibiotic prophylaxis between January and November 2020. Patients with left ventricular assist device implantation, concomitant infectious pathology, receipt of other antibiotics within 24 hours, or allergy to beta-lactams were excluded.
Patients who received preoperative vancomycin with a cephalosporin were included in the combination therapy group and compared to patients who received a cephalosporin alone. Case-matching based on the presence of diabetes and body mass index was performed to minimize confounding. The primary outcome of this study was overall postoperative SWI within 30 days. This outcome was assessed using a chi square test with a p-value less than 0.05 indicating significance.
Results:
Of the 339 analyzed patients, 184 patients met criteria for inclusion. There was no significant difference in incidence of overall SWI between monotherapy and combination groups (3 versus 4 respectively, p=0.69). There were also no significant differences in secondary outcomes including but not limited to 30-day mortality, readmission, or reoperation. Incidence of acute kidney injury (AKI) was numerically higher in the combination therapy group, although this was not significant.
Conclusion:
Addition of vancomycin to a cephalosporin did not reduce incidence of SWI prior to cardiac surgery and may have increased incidence of adverse events such as AKI. However, this study is limited by sample size, and more research is needed to determine impact of patient-specific risk factors.