BOLON MK, MORLOTE M, WEBER S, CARMELI Y, WRIGHT S; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-1295.

Beth Israel Deaconess Medical Center, Boston, MA.

BACKGROUND: The proportion of SSI caused by methicillin-resistant (MR) gram-positive cocci (GPC) is increasing. GLY could provide better prophylaxis against infection for cardiac surgery procedures than BL. METHODS: Studies were identified using a Medline search. Only randomized studies comparing SSI in cardiac surgery patients who received prophylaxis with GLY vs. BL were included. Data were abstracted and authors contacted for additional data. The primary outcome was occurrence of SSI within 30 days after surgery. We also examined the effect of prophylaxis choice on infection at different anatomical sites and on the causative organism. Results were analyzed using a random effects model. RESULTS: Of 760 studies identified, 7 met inclusion criteria. GLY prophylaxis was given for 2,879 procedures and BL for 2,882. 515 SSI occurred (8.9%). One study reported a higher risk of SSI with GLY; the other 6 did not find a significant difference between groups. Pooled results revealed a risk ratio (RR) for SSI in patients receiving GLY of 1.14 (95% CI 0.91-1.42, p=0.27) as compared to those receiving BL. Pooled results showed increased risk for chest SSI in the GLY group (303 episodes; RR 1.47; 95% CI 1.11-1.95, p=0.008). 309 infections were caused by GPC. These infections tended to occur more often after GLY prophylaxis (RR 1.36, 95% CI 0.98-1.91, p=0.07). 4 studies (2,286 procedures) reported 67 infections caused by MR-GPC. Among these, the risk of infection caused by MR-GPC was lower in the GLY group (RR 0.54, 95% CI 0.33-0.9, p=0.017). CONCLUSIONS: Overall, GLY prophylaxis was no more effective than BL in preventing SSI. GLY were less effective in preventing chest infections, but more effective in preventing SSI due to MR-GPC. However, this came at the expense of potentially reduced effectiveness against non-resistant GPC. Our results suggest that standard prophylaxis for cardiac surgery should continue to be BL in most circumstances.

Publication Types:

• Meeting Abstracts

Keywords:

• Antibiotic Prophylaxis
• Bacteremia
• Communicable Diseases
• Cross Infection
• Glycine
• Glycopeptides
• Humans
• Infection
• Meta-Analysis
• Odds Ratio
• Surgical Wound Infection
• Thoracic Surgery
• United States
• beta-Lactams
• drug therapy
• prevention & control
• therapy

Other ID:

• GWAIDS0026593

UI: 102266217

From Meeting Abstracts