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Ann Thorac Surg 2006;81:397-404
© 2006 The Society of Thoracic Surgeons

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Report from the workforce on evidence-based medicine

The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part I: Duration _^*

^a Division of Cardiothoracic Surgery, University of Florida, Jacksonville, Florida
^b Division of Cardiac Surgery Research, Baystate Medical Center, Springfield, Massachussetts
^c School of Public Health and Community Medicine, Department of Epidemiology, University of Washington, Seattle Washington
^d Department of Surgery, Caritas St. Elizabeth's Medical Center, Boston, Massachussetts
^e Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania

^_* Address correspondence to Dr Edwards, Cardiothoracic Surgery, University of Florida/Shands Jacksonville, Jacksonville, FL 32209 (Email: fred.edwards@jax.ufl.edu).

The first 300 words of the full text of this article appear below.

	I. Overview

 
Prophylactic intravenous antibiotics should be routinely administered to patients undergoing cardiac surgery. Although this is a well-accepted tenet of contemporary practice, the duration during which the antibiotics should be given is far from settled. As one may see from the studies discussed as follows, in the field of cardiac surgery there is wide variation in prophylactic antibiotic duration (PAD) across the United States as well as other countries.

In other surgical specialties, there seems to be little debate regarding PAD. However, in cardiac surgery there are several factors that contribute to the divergence of practice patterns: (1) The question of optimum duration has not been adequately explored with identical antibiotic regimens administered to groups differing only in the duration of prophylaxis; (2) surgical-site infections have been low during the years, implying that present practice is effective and need not be changed; and (3) there has been only a vaguely perceived downside to aggressive, prolonged prophylaxis.

However today there is mounting evidence of important disadvantages to prolonged prophylaxis. Emerging antibiotic resistance was once regarded as an ill-defined notion that received only passing notice [1, 2]. There is now considerable evidence that this problem is: (1) real, (2) clinically important, and (3) directly linked to the duration of prophylactic antibiotic administration. This fact alone is enough to prompt a reassessment of our practice, but in addition we now face the introduction of quality metrics linked to third party pay for performance initiatives [3]. In virtually all of these pay for performance programs, the duration of prophylactic antibiotics will be used as a quality metric. For example, one of the quality measures used in a demonstration project sponsored by the Center for Medicare and Medicaid Services specifies that prophylactic antibiotics in cardiac surgery should be administered for no more . . . [Full Text of this Article]

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