Lok M Sinha, Aftab Yunus, Shafqat Hussain, Mulazim Hussain.
Antibiotic Prophylaxis for Preventing Surgical Site Infection after Coronary Artery Bypass Graft: Prospective Randomized Comparative Study.
Pak J Med Health Sci Jan ;6(3):742-5.

Objectives: To compare the outcome of short-term (<24 hours) versus longer-term (>24 hours) antibiotic prophylaxis in patients undergoing coronary artery bypass graft (CABG) surgery and its impact on deep Sternal Wound Infection (DSWI) / Mediastinitis. Patients and methods: To compare the effect of short (<24 hours) versus prolonged (>24 hours) ABP on surgical site infections (SSIs) and acquired antimicrobial resistance, Cross sectional comparative study was conducted. Prospective surveillance of 200 patients undergoing isolated CABG surgery (on pump/off pump) fulfilling the inclusion and exclusion criteria were included in the study. Comparison were made between 100 patients receiving less than 24 hours of prophylactic antibiotics with another 100 patients receiving more than 24 hours of prophylactic antibiotics. Surgical Site infection (SSI) was assessed on a daily basis during the patient's stay in the Department of Cardiac Surgery, Mayo Hospital/KEMU, Lahore. Diagnosis of identified SSI were based on positive cultures, clear dehiscence of the sternotomy wound, fever, pain, redness, secretion, purulent drainage, and sternal instability. The main exposure was the duration of ABP, and the primary outcome measure was DSWI (Mediastinitis). Results: During the study period 9 patients developed DSWI/Mediastinitis, the infection rates were 4% in the group < 24 h of ABP and 5% in the group receiving >24 h of ABP therapy, and the difference was statistically non-significant (P=0. 774). The proportion of patients with deep-organ-space involvement (mediastinitis) and sepsis requiring rewiring were 3 patients (3%) for <24 hours and 4 patients (4%) in >24 hours of ABP (P=0.700). There were no differences between groups for mortality or duration of hospitalization (preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention). The microorganisms isolated showed a similar distribution in both groups. Test of proportion was applied and it was found that there was no difference in the proportion of infection in the two groups (p value 0.05). Conclusion: Findings confirm that a prophylactic Antibiotic combination using Vancomycin and an aminoglycoside of 24 hours duration is as effective as prophylaxis administered for longer than 24 hours regimen for preventing surgical site infection in patients undergoing isolated CABG.

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