A national survey of antimicrobial prophylaxis in adult cardiac surgery across Canada

OBJECTIVE:

To characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada.

DESIGN:

Retrospective, cross-sectional analysis.

SETTING:

Thirty-three adult cardiac surgical centres across Canada.

INTERVENTIONS:

A one-page questionnaire collecting information regarding institutional demographics and antimicrobial prophylaxis regimens for adult cardiac surgical procedures was mailed to all adult surgical centres across Canada. If a response was not received within one month, a second survey was mailed, followed by a telephone reminder within two weeks of the second mailing.

MAIN RESULTS:

The Overall response rate was 100%. Prophylactic antimicrobials were used in all the adult cardiac centres; single-agent prophylaxis was used in 97% (32 of 33) of centres; Single-dose antimicrobial prophylaxis was used in only 3% (one of 33) of centres. Preoperative and postoperative antimicrobial prophylaxis regimens varied both between provinces and within provinces across Canada. Cefazolin was the antimicrobial used in 88% (38 of 43) and 87% (33 of 38) of the reported pre-operative and post-operative prophylaxis regimens, respectively. Antimicrobial prophylaxis was initiated in the operating room 72% (26 of 36) of the time and intra-operative supplemental antimicrobial doses were administered for cardiac procedures longer than a median of 4 hours (range 4 to 8 hr). Overall, the median duration of antimicrobial prophylaxis was 36 hours (range 8 to 96 hr).

CONCLUSIONS:

Despite the availability of various published guidelines, our survey identified several areas for improvement with respect to antimicrobial prophylaxis in adult cardiac surgery across Canada.Key Words: Antibiotics, Cardiac surgical procedures, Prophylaxis, Surgical wound infectionPostoperative infections complicating cardiac surgery are associated with serious complications (e.g. mediastinitis, osteomyelitis, sternal wound infections and endocarditis), that result in significant morbidity, mortality, and increased costs (1-3). Despite evidence that antimicrobial prophylaxis is beneficial in reducing these complications, the optimal prophylactic regimen in cardiac surgery has not been defined (4-8). According to the 1999 Guidelines for Coronary Artery Bypass Graft Surgery from the American College of Cardiology (ACC) and the American Heart Association (7), "Many centres, including those with training programs in cardiothoracic surgery, are not consistent in delivering or teaching effective use of perioperative antibiotics".Although antimicrobial prophylaxis practice patterns in cardiac surgery have been documented for other geographical regions, the antimicrobial prophylaxis practice in adult cardiac surgery across Canada has not been documented to date (9-13). This information, in conjunction with the available literature, would be extremely useful for the development and/or revision of local guidelines for antimicrobial prophylaxis in cardiac surgery.The objective of this nationwide survey was to characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada.