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Ann Thorac Surg 2007;83:1569-1576
© 2007 The Society of Thoracic Surgeons
a Baystate Medical Center, Springfield, Massachusetts
b Tufts University School of Medicine, Boston, Massachusetts
c Boston Medical Center, Boston, Massachusetts
d University of California, San Francisco, California
e Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
f University of Florida, Shands Jacksonville, Jacksonville, Florida
g St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
h University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
* Address correspondence to Dr Engelman, Baystate Medical Center, Division of Cardiac Surgery, 759 Chestnut St, Springfield, MA 01199 (Email: richard.engelman@bhs.org).
| The first 300 words of the full text of this article appear below. |
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I. Overview |
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Part I of this evidence-based guideline series (The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part I: Duration, published in the January 2006 issue of the Annals of Thoracic Surgery) recommended that the duration for routine postoperative administration of prophylactic antibiotics be no longer than 48 hours [7]. This initial Guideline did not define the choice of antibiotic to be recommended, its dose, or frequency of administration. Those subjects are the basis for this report.
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II. Choice of Primary Prophylactic Antibiotic |
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There are numerous publications concerned with the optimal prophylactic antibiotic recommended for cardiac surgery, but many of these protocols are comparing not only two or more antibiotic regimens but also two different dosing programs, for example, single dose versus multidose, which was addressed in the previous Guideline. This second published Guideline will address additional publications in so far as they compare different antibiotic regimens involving comparable duration of multidose antibiotic administration.
The most pertinent report appeared in 2004 [8] and was a very complete meta-analysis of seven randomized trials, comparing the incidence of SSIs in patients receiving either glycopeptide prophylaxis (vancomycin or teicoplanin) or a ß-lactam. Five of the seven trials used a multidose regimen
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