Evaluation of the Prophylactic Antibiotic Policies of Cardiac Surgery in a University Teaching Hospital

Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of postoperative infection. Inappropriate antimicrobial prophylaxis, as inappropriate selection of the antimicrobial agent or dosing regimen, can increase the prevalence of antibiotic resistant strains, prolong hospital stay, cause postoperative infection, and negatively affect an institution’s pharmacy budget for antibiotics. To assess the current postoperative prophylactic antibiotic protocols applied in the cardiac surgeries department in Ain Shams University teaching hospitals with respect to others and to international guidelines for antimicrobial prophylaxis practice in cardiac surgery. Total of 320 paediatric and adult patients who were admitted for cardiac surgery to Ain Shams University teaching hospitals from September 2012 till March 2013.The antimicrobial prophylaxis indication, choice, duration, dose, dosing interval, and timing appropriateness were assessed against 3 international guidelines using a pre-tested, structured clinical data collection form. All patients were monitored daily during their inpatient stay until discharge. Data regarding surgery duration, mechanical ventilation duration, intensive care unit stay, postoperative stay and total hospital stay were obtained. Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients. A statistical significant difference for the mechanical ventilation duration, intensive care unit stay, postoperative stay and total hospital stay were found concerning both the paediatrics and the adults between the infected and non-infected group. Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in cardiothoracic department at Ain Shams University teaching hospitals, leading to the inappropriate administration of many antibiotics.