• J. Cardiothorac. Vasc. Anesth. · Dec 2015

    Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections During Cardiac Surgical Procedures: A Propensity-Matched Analysis.

    • J Trent Magruder, Joshua C Grimm, Samuel P Dungan, Ashish S Shah, Jessica R Crow, Bethany R Shoulders, Laeben Lester, and Viachaslau Barodka.
    • Cardiac Surgery. Electronic address: jmagrud3@jhmi.edu.
    • J. Cardiothorac. Vasc. Anesth. 2015 Dec 1;29(6):1582-7.

    ObjectivesThe authors sought to determine whether an institutional transition from intermittent to continuous dosing of intraoperative antibiotics in cardiac surgery affected surgical site infection (SSI) outcomes.DesignA retrospective chart review utilizing propensity matching.SettingA single academic, tertiary care hospital.ParticipantsOne thousand one hundred seventy-nine patients undergoing coronary artery bypass grafting (CABG) and/or cardiac valvular surgery between April 2013 and November 2014 who received perioperative cefazolin.InterventionsBy method of cefazolin administration, patients were divided into an "intermittent-dosing" (ID) group and a "continuous-infusion" (CI) group.Measurements And Main ResultsOf the 1,179 patients who underwent cardiac surgery during the study period, 1:1 propensity score matching yielded 399 patients in each group. Rates of diabetes (33.6% ID v 33.8% CI, p = 0.94), coronary artery bypass (62.3% v 61.4%, p = 0.66), and bilateral internal mammary artery harvesting (6.0% v 8.3%, p = 0.22) were similar between groups. SSIs occurred in more ID patients than CI patients (2.3% v 0.5%, p = 0.03). This difference was driven by decreases in extremity and conduit harvest site SSIs (1.8% v 0.3%, p = 0.03), as there were no episodes of mediastinitis, and superficial sternal SSI rates did not differ (0.5% v 0.3%, p = 0.56). There also were significantly fewer episodes of pneumonia in the CI group (6.0% v 2.3%, p = 0.008). Intensive care unit and total lengths of stay did not differ. Thirty-day mortality was 2.8% in both groups (p = 1.00).ConclusionsAs compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.Copyright © 2015 Elsevier Inc. All rights reserved.

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