Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis

Results: Fifty-nine trials were included. There were no significant differences in DSWI or all other categories of surgical site infections (SSIs) for antibiotic prophylaxis with b-lactams comprising a Gram-negative spectrum of coverage versus prophylaxis targeting Gram-positive bacteria, but the former led to a significantly lower rate of post-operative pneumonia (RR 0.68, 95% CI 0.51 –0.90) and all-cause mortality (RR 0.66, 95% CI 0.47 –0.92). In trials comparing different antibiotic regimens for different durations, prophylaxis duration of ≤24 h post-operation led to higher rates of DSWI (RR 1.83, 95% CI 1.25 –2.66), any sternal SSI, surgical interventions for SSI and endocarditis compared with longer duration prophylaxis. There was no advantage of regimens lasting .48 h post-operation. In the comparison of glycopeptides versus b-lactams, an advantage of glycopeptides was observed when comparators were given for similar duration and for b-lactams when given for a longer duration than the glycopeptides. There was no significant advantage of high antibiotic dosing. Conclusions: Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively.