Title : Impact of optimizing antibiotic prophylaxis policy on surgical site infections
Administration of prophylactic antibiotics is a standard practice before cardiac surgeries. The previously recommended prophylactic antibiotics for cardiac surgeries were Cefuroxime and Levofloxacin. Patients were monitored up to three months post-surgery ascertained through routine infection control surveillance using the National Healthcare Safety Network (NHSN) methodology. Prospective cohort study was planned. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes.
Surgical safety checklists were strictly followed and documented. No gaps could be found on patient preparation and repeated audits in operation rooms. Choice of prophylactic antibiotics were reviewed. Levofloxacillin sensitivity was found to be only 20% when local antibiogram was prepared and all susceptibilities analyzed. Levofloxacillin was also theoretically associated with induction of different resistant genes like extended spectrum beta-lactamases. Other country guidelines were consulted and it was unanimously decided to change the prophylactic regimen. According to National Health Service, Flucloxacillin and Gentamicin were chosen.
1909 patients were considered from January 2017 to February 2018. These patients received the previous antibiotic prophylaxis regimen. 2823 patients were included after the new antibiotic policy was established (March 2018 to December 2019). SSI rates were compared and the p-value was found highly significant.
We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative antibiotic prophylaxis in cardiac surgery.