Abstract
According to the “guideline for prevention of surgical site infection (SSI)” published by the Centers for Disease Control and Prevention (CDC) in 1999, we selected two agents for anti-microbial prophylaxis. We adopted these agents for patients undergoing cardiac and thoracic aortic surgery. Anti-microbial agents were injected one hour prior to making the incision, and one final injection again after the operation. This protocol was applied consecutively to 120 patients treated by the same surgeon from September 1999 to January 2002. The first group (59 patients) received sulbactam/ampicillin (SBT/ABPC). The selection of this drug was based on the sensitivity rate for 58 colonies of coagulase negative staphylococci cultured at our institute. The second group (61 patients) received cefazolin (CEZ). This drug was selected because it was recommended by the CDC as being the most popular anti-microbial prophylaxis. The incidence of SSI was 3.4% (2/59) in the SBT/ABPC group, and 9.8% (6/61) in the CEZ group (NS). The incidence of deep incisional SSI was 1.7% (1/59) in the SBT/ABPC group, and 4.9% (3/61) in the CEZ group (NS). The incidence of SSI in patients with ischemic heart disease was 4.0% (1/25) in the SBT/ABPC group, and 14.6% (6/41) in the CEZ group (NS). The incidence of deep incisional SSI in patients with ischemic heart disease was 0% (0/25) in the SBT/ABPC group, and 7.3% (3/41) in the CEZ group (NS). We concluded that CDC's recommendations concerning anti-microbial prophylaxis for cardiac and vascular surgery is effective when using SBT/ABPC at our hospital. The rate of multi-drug resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), is very high in Japan. Therefore shortening the period of prophylactic antibiotics decreased enfective complications that arise with multi-drug resistant bacteria excluding MRSA.
