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, Viachaslau Barodka

Research output: Contribution to journalArticle

Abstract

Objectives The 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. Design A retrospective chart review utilizing propensity matching. Setting A single academic, tertiary care hospital. Participants One 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. Interventions By method of cefazolin administration, patients were divided into an "intermittent-dosing" (ID) group and a "continuous-infusion" (CI) group. Measurements and Main Results Of 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). Conclusions As compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.

Original languageEnglish (US)
Pages (from-to)1582-1587
Number of pages6
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume29
Issue number6
DOIs
StatePublished - Dec 1 2015

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Cardiac Surgical Procedures
Surgical Wound Infection
Cefazolin
Thoracic Surgery
Coronary Artery Bypass
Mediastinitis
Propensity Score
Mammary Arteries
Tertiary Healthcare
Tertiary Care Centers
Intensive Care Units
Length of Stay
Pneumonia
Extremities
Anti-Bacterial Agents
Mortality

Keywords

  • cardiac surgical procedures
  • cefazolin
  • mediastinitis
  • perioperative care
  • postoperative wound infections
  • sternum

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections during Cardiac Surgical Procedures : A Propensity-Matched Analysis. / Trent Magruder, J.; Grimm, Joshua C.; Dungan, Samuel P.; Shah, Ashish S.; Crow, Jessica R.; Shoulders, Bethany R.; Lester, Laeben; Barodka, Viachaslau.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 29, No. 6, 01.12.2015, p. 1582-1587.

Research output: Contribution to journalArticle

Trent Magruder, J. ; Grimm, Joshua C. ; Dungan, Samuel P. ; Shah, Ashish S. ; Crow, Jessica R. ; Shoulders, Bethany R. ; Lester, Laeben ; Barodka, Viachaslau. / Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections during Cardiac Surgical Procedures : A Propensity-Matched Analysis. In: Journal of Cardiothoracic and Vascular Anesthesia. 2015 ; Vol. 29, No. 6. pp. 1582-1587.
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abstract = "Objectives The 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. Design A retrospective chart review utilizing propensity matching. Setting A single academic, tertiary care hospital. Participants One 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. Interventions By method of cefazolin administration, patients were divided into an {"}intermittent-dosing{"} (ID) group and a {"}continuous-infusion{"} (CI) group. Measurements and Main Results Of 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). Conclusions As compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.",
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T2 - A Propensity-Matched Analysis

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AU - Grimm, Joshua C.

AU - Dungan, Samuel P.

AU - Shah, Ashish S.

AU - Crow, Jessica R.

AU - Shoulders, Bethany R.

AU - Lester, Laeben

AU - Barodka, Viachaslau

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N2 - Objectives The 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. Design A retrospective chart review utilizing propensity matching. Setting A single academic, tertiary care hospital. Participants One 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. Interventions By method of cefazolin administration, patients were divided into an "intermittent-dosing" (ID) group and a "continuous-infusion" (CI) group. Measurements and Main Results Of 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). Conclusions As compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.

AB - Objectives The 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. Design A retrospective chart review utilizing propensity matching. Setting A single academic, tertiary care hospital. Participants One 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. Interventions By method of cefazolin administration, patients were divided into an "intermittent-dosing" (ID) group and a "continuous-infusion" (CI) group. Measurements and Main Results Of 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). Conclusions As compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.

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