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Clinical pharmacy and clinical trials (including case series)
Antibiotic prophylaxis and incidence of endocarditis and mediastinitis in patients undergoing cardiac surgery
  1. L. Calixto,
  2. A. Atalaia,
  3. T. Laranjeira,
  4. A. Mirco,
  5. F. Falcão
  1. 1CHLO EPE – Hospital Santa Cruz, Pharmacy, Lisbon, Portugal


Background Mediastinitis and endocarditis after cardiac surgery are serious complications that increase short and long term morbidity and mortality and also costs. Antibiotic prophylaxis aims to reduce the risk of surgical wound infection; however these infections occur in 0.4 to 4% of cardiac surgery procedures.

Purpose To evaluate compliance with prophylactic antibiotic guidelines at Hospital Santa Cruz (HSC) Portugal in cardiac surgery. To assess the incidence of mediastinitis and endocarditis after cardiac surgery.

Materials and methods A retrospective study was performed in 456 patients undergoing cardiac surgery (replacement/valve repair, coronary bypass graft (CABG) or both) by sternotomy, between January and December 2010. Data were collected from medical and pharmaceutical databases and other records available in the hospital.

Results 456 patients were evaluated in this study, 74% male, with an average age of 68±12 years (range 22-90 years). Of these patients 45.6% underwent valve surgery (VS), 44.3% coronary artery bypass surgery (CABG) and 10.1% underwent both procedures. The prophylactic regimens used were cefazolin in monotherapy (45.8%), cefazolin + vancomycin (2.0%), vancomycin + gentamicin (52.2%), with an average duration of 1.5±0.8 days. The cefazolin monotherapy was used more frequently in CABG (42.8%) and vancomycin + gentamicin in VS (42.2%). The incidence of endocarditis and mediastinitis was 3.55%.

Conclusions The prophylactic regimens used in cardiac surgery at HSC are in agreement with international and local guidelines. Given the high prevalence of MRSA in HSC, vancomycin and gentamicin were often used, as referred to in the literature. The incidence of postoperative endocarditis and mediastinitis is similar to that reported in several studies.

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