A national survey of antimicrobial prophylaxis in adult cardiac surgery across Canada

Abstract

OBJECTIVE: To characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada. DESIGN: Retrospective, cross-sectional analysis. SETTING: Thirty-three adult cardiac surgical centres across Canada. INTERVENTIONS: A one-page questionnaire collecting information regarding institutional demographics and antimicrobial prophylaxis regimens for adult cardiac surgical procedures was mailed to all adult surgical centres across Canada. If a response was not received within one month, a second survey was mailed, followed by a telephone reminder within two weeks of the second mailing. MAIN RESULTS: The overall response rate was 100%. Prophylactic antimicrobials were used in all of the adult cardiac centres; single-agent prophylaxis was used in 97% (32 of 33) of centres. Single-dose antimicrobial prophylaxis was used in only 3% (one of 33) of centres. Preoperative and postoperative antimicrobial prophylaxis regimens varied both between provinces and within provinces across Canada. Cefazolin was the antimicrobial used in 88% (38 of 43) and 87% (33 of 38) of the reported preoperative and postoperative prophylaxis regimens, respectively. Antimicrobial prophylaxis was initiated in the operating room 72% (26 of 36) of the time, and intraoperative supplemental antimicrobial doses were administered for cardiac procedures that took longer than a median of 4 h (range 4 to 8 h). Overall, the median duration of antimicrobial prophylaxis treatment was 36 h (range 8 to 96 h). CONCLUSIONS: Despite the availability of various published guidelines, the present survey identified several areas for improvement with respect to antimicrobial prophylaxis in adult cardiac surgery across Canada.