Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery

Objectives. To examine the efficacy of a protocol for the prophylactic use of antimicrobials in pediatric cardiac surgery. Design: Nonrandomized comparison of two groups of patients studied sequentially. Setting: Pediatric intensive care unit of university hospital. Patients: Infants and children < 18 yrs of age who had undergone cardiac surgery. Interventions: Limitation of prophylactic antimicrobials to < 48 hrs after operation and, in patients at high risk of methicillin-resistant Staphylococcus aureus, strong recommendation to use glycopeptides. Measurements and Main Results: No intervention was applied in 189 patients (control group) during the first 21 months, whereas the intervention was applied in 185 patients (intervention group) during the next 18 months. In the intervention group, prophylaxis was recommended to be discontinued < 48 hrs postoperatively. As a result, antimicrobials were administered for a median of 4 days (range 2-14) in the intervention group, significantly shorter than 7 days (3-35) in controls. This was associated with a trend toward a lower frequency of postoperative infections, including at the surgical site, and with significantly lower costs of antimicrobial therapy and a significantly lower rate of newly acquired nasal colonization with antibiotic-resistant pathogens in the intervention group (8%) than in controls (17%). 1 Since, in the intervention group, glycopeptides were strongly recommended for patients at high risk of methicillin-resistant S. aureus, the frequency of surgical-site infections (0% vs. 18%) and the frequency of all infections (11% vs. 39%) were significantly lower in the intervention group than in the control group. Conclusions: Limiting the duration of prophylactic antimicrobials was cost-effective and reduced the risk of acquiring resistant pathogens without increasing the frequency of postoperative infections. The use of glycopeptides in properly selected patients at high risk of methicillin-resistant S. aureus infection can lower the risk of postoperative infections.