January 15, 2014
Two-Hour Window Optimal for Cardiac Surgery Antibiotics

Haifa, Israel—Timing is everything when administering preoperative antibiotic therapy to decrease the risk of developing surgical site infections (SSIs) in cardiac surgery.

That’s according to a new Israeli study, published recently in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. Researcher found that antibiotics administered within 2 hours of surgery were most effective.

“Antimicrobial prophylaxis can reduce the risk of SSIs following many operations, however that efficacy diminishes or disappears if antibiotics are given either too early or after incision,” said lead author Renato Finkelstein, MD, of Rambam Medical Center. “Despite the general acceptance of this concept in guidelines, wide variations in preoperative antibiotic administration practices have been reported.”

“Antibiotic prophylaxis can reduce the risk of SSI after many operations, including cardiac surgery; however, appropriate surgical prophylaxis is a multifactorial enterprise that depends on proper case selection, antibiotic selection, dosing and route of administration, duration of therapy and, for lengthy procedures, intraoperative dosing,” the authors write in the article’s introduction.

The 10-year prospective cohort study, which included 2,537 patients, emphasized an optimized policy for preoperative antibiotic prophylaxis in cardiac surgery. That policy included administering the first dose of antibiotic prophylaxis up to 2 hours before the first surgical incision. Prophylaxis given at a different time ranged in administration of 3 hours before or after the surgery.

Researchers found that SSIs were significantly less common among patients who received prophylaxis during the optimized period than patients who received antibiotic prophylaxis at a different time.

Results indicated that 8.3% (206 patients of 2,536) who received preoperative antibiotics within a 2-hour window of the first incision developed an SSI, compared with 13.9% (14 of 101) of patients who received antibiotic prophylaxis at a different time.

By the last 2 years of the study, nearly complete compliance with the 2-hour window was achieved, according to the report.

“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,” the authors conclude.

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