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The appropriate use of antibiotics prophylaxis reduces the incidence of surgical site infections. Despite advances in antiseptic measures, antibiotics, and preoperative precautions, infections are common complications from surgeries. This study was conducted to assess the appropriateness of the prescription of antibiotics prophylaxis prior to cardiac surgery among hospitalized patients in the geographic area of Lebanon. This was a retrospective, observational, single center study conducted at a public Lebanese teaching hospital from February till April 2014. Data were collected from computerized data bases for hospitalized patients who did cardiac surgeries from January 2010 till December 2013. Patients above eighteen years old undergoing CABG (coronary artery by-pass graft), valve surgery, or both were eligible for study enrollment. Excluded were patients younger than eighteen years of age, prior intake of antibiotics, or had another concomitant surgery with the cardiac. Consistency with the guidelines was evaluated for appropriate route of administration, choice, preoperative timing, duration, dosing, and redosing of antibiotics. The IRB (Institutional Review Board) approved the study design. Data were analyzed by the SPSS version 20.0 and presented as frequency/percentage and mean ± SD (standard deviation). A total of 3,000 patients were initially screened where only 245 patients met the inclusion criteria. Baseline age of the participants was 58.91 ± 13.65 years (mean ± standard deviation SD), and a body mass index of 28.19 ± 5.19 Kg/m. The enrolled participants were on different intravenous antibiotic regimens, where 188 (76.7%) patients were on vancomycin and ceftriaxone, 15 (6.1%) on vancomycin and cefuroxime, 13 (5.3%) on ceftriaxone, 12 (4.9%) on vancomycin, 6 (2.4%) on cefuroxime, 2 (0.8%) on clindamycin), and the others were on combination of gentamicin and a cephalosporin. Only twelve (4.9%) from the enrolled patients were consistent with the treatment guidelines regarding the choice of the antibiotic. For those patients who were given the appropriate antibiotics, proper dose was found in only seven patients (58.7%). Five patients out of 254 (2%) required redosing where four were given the appropriate doses. As for preoperative timing it was appropriate for all of those cases (i.e. within 120 minutes of incision for vancomycin and within 60 minutes for cefuroxime and clindamycin). Prophylaxis was extended beyond one day in 173 patients (70.61%) and the average duration was 2.8531 days ± 2.07514. This study demonstrates that in cardiac surgery, the optimal choice of antibiotics is seldom administered, duration of prophylaxis is excessively long, and the preoperative dose timing is rarely employed. More education and communication are required to improve these practices to reduce risks of surgical site infection, prevent resistance, and limit costs potentially associated with antibiotic misuse. The role of clinical pharmacist may facilitate this process across all surgical disciplines through interventions that should be implemented to optimize the perioperative antibiotic prophylaxis in procedures.

Assessment of Cardiovascular Surgical Infection Prophylaxis in a Lebanese Hospital