The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery

• Published in: Journal of cardiothoracic surgery Vol. 17; no. 1; p. 15
• Main Authors: Bae, Sung-Jin, Kim, Inah, Song, Jaechul, Chung, Euy-Suk
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.02.2022; BioMed Central; BMC
• Subjects: Adult; Analysis; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Bacteria; Cardiac patients; Cardiac Surgical Procedures; Cefazolin; Ceftizoxime; Costs; Expenditures; Fees & charges; Gram-negative bacteria; Gram-positive bacteria; Health Expenditures; Heart; Heart surgery; Hospital patients; Hospitalization; Hospitals; Humans; Hypertension; Infection; Infections; Medical economics; Medical expenditures; Methicillin; Mortality; Nosocomial infections; Ostomy; Patients; Propensity score matching; Prophylactic antibiotics; Prophylaxis; Regression analysis; Risk analysis; Risk factors; Surgery; Surgical site infection; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; United States > US; Propensity score matching; Surgical site infection; Prophylactic antibiotics; Medical expenditures
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-022-01763-4

This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs. All adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis. The incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD). In conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.