心脏手术抗生素预防的持续时间：前瞻性观察研究。

Duration of antibiotic prophylaxis for cardiac surgery: prospective observational study.

作者信息

Paul Mical, Porat Eyal, Raz Aeyal, Madar Hefziba, Fein Shai, Bishara Jihad, Biderman Phillippe, Medalion Benjamin, Sharoni Erez, Eidelman Leonid, Leibovici Leonard, Rubinovitch Bina

机构信息

Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tikva, Israel.

出版信息

J Infect. 2009 Apr;58(4):291-8. doi: 10.1016/j.jinf.2009.02.008. Epub 2009 Mar 14.

DOI:10.1016/j.jinf.2009.02.008

PMID:19286263

Abstract

OBJECTIVES

To assess the effect of prolonging antibiotic prophylaxis in cardiac surgery.

METHODS

Prospective before-after cohort study. In 2004, cefazolin was given pre- and intraoperatively at 1g doses while in 2007 it was continued after surgery for 24h. All consecutive adult patients undergoing coronary artery bypass graft, valve, and/or aortic operations during the study periods were included. The primary outcomes were deep sternal wound infection (DSWI) and mortality. Univariate and multivariate analyses were conducted to assess risk factors for DSWI.

RESULTS

954 patients between 1/2004 and 12/2004 were compared to 424 patients between 1/2007 and 6/2007. In 2007, there were significantly more patients >60yrs., emergency and combined operations and the mean logistic EuroSCORE was higher compared to 2004 (8.53% vs. 6.92%, p=0.006). The rate of DSWI decreased non-significantly from 3.8% (36/954) in 2004 to 2.6% (11/424) in 2007, p=0.27. The adjusted odds ratio of the study period for DSWI was 0.89 (95% confidence interval 0.70-1.13). There was no difference in 30-day (5.2% vs. 5.4%) or 6-month mortality (9.2% in both periods), despite increasing patients' risk.

CONCLUSIONS

Increasing the duration of antibiotic prophylaxis did not result in a significant decrease in DSWI. The value of prolonging antibiotic prophylaxis after cardiac operations should be further evaluated.

摘要

目的

评估延长心脏手术抗生素预防用药时间的效果。

方法

前瞻性前后队列研究。2004年，头孢唑林在术前和术中给予1g剂量，而2007年术后继续用药24小时。纳入研究期间所有连续接受冠状动脉搭桥术、瓣膜手术和/或主动脉手术的成年患者。主要结局为深部胸骨伤口感染（DSWI）和死亡率。进行单因素和多因素分析以评估DSWI的危险因素。

结果

将2004年1月至2004年12月的954例患者与2007年1月至2007年6月的424例患者进行比较。2007年，年龄>60岁、急诊和联合手术的患者明显更多，与2004年相比，平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）更高（8.53%对6.92%，p=0.006）。DSWI发生率从2004年的3.8%（36/954）降至2007年的2.6%（11/424），差异无统计学意义，p=0.27。研究期间DSWI的调整优势比为0.89（95%置信区间0.70-1.13）。尽管患者风险增加，但30天死亡率（5.2%对5.4%）或6个月死亡率（两个时期均为9.2%）无差异。