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J Thorac Cardiovasc Surg. 2016 Feb;151(2):589-97.e2. doi: 10.1016/j.jtcvs.2015.09.090. Epub 2015 Sep 28.

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery.

Author information

1
Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: jashvant.poeran@mountsinai.org.
2
Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY.
3
Department of Pharmacy, The Mount Sinai Hospital, New York, NY.
4
Icahn School of Medicine at Mount Sinai, New York, NY.
5
Icahn School of Medicine at Mount Sinai, New York, NY; Infection Prevention and Control, Mount Sinai Health System, New York, NY.
6
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

OBJECTIVE:

Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for Clostridium difficile. Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. We aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and C difficile among patients undergoing coronary artery bypass grafting.

METHODS:

We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006-2013, n = 154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2 days, "standard" vs ≥2 days, "extended") and (2) type of antibiotic used ("cephalosporin," "cephalosporin + vancomycin," "vancomycin") and C difficile as outcome.

RESULTS:

Overall C difficile prevalence was 0.21% (n = 329). Most patients (59.7%) received a cephalosporin only; in 33.1% vancomycin was added, whereas 7.2% received vancomycin only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased C difficile risk (odds ratio, 1.43; confidence interval, 1.07-1.92), whereas no significant associations existed for vancomycin use as adjuvant or primary prophylactic compared with the use of cephalosporins (odds ratio, 1.21; confidence interval, 0.92-1.60, and odds ratio, 1.39; confidence interval, 0.94-2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5-35.7), use of adjuvant vancomycin (interquartile range, 4.2-61.1), and vancomycin alone (interquartile range, 2.3-10.4).

CONCLUSIONS:

Although extended use of antibiotic prophylaxis was associated with increased C difficile risk after coronary artery bypass grafting, vancomycin use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce C difficile risk.

KEYWORDS:

Clostridium difficile; antibiotic prophylaxis; coronary artery bypass graft; vancomycin

PMID:
26545971
PMCID:
PMC5142529
DOI:
10.1016/j.jtcvs.2015.09.090
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Statement Authors have nothing to disclose with regard to commercial support.

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