Antibiotic prophylaxis and risk of XXXX infection after coronary artery bypass graft surgery.

@entity1 @entity2176 @entity2886 @entity2718 @entity8509
OBJECTIVE: Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for @entity2718 . Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48  hours or less (vs   <=24  hours for noncardiac surgery), with increasing @entity2176 use. We aimed to study associations between antibiotic prophylaxis (duration/ @entity2176 use) and @entity2718 among @entity1 undergoing coronary artery bypass grafting. METHODS: We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006-2013, n  =  154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2  days, "standard" vs >= 2  days, "extended") and (2)  type of antibiotic used (" @entity8509 ," " @entity8509  +  @entity2176 ," " @entity2176 ") and @entity2718 as outcome. RESULTS: Overall @entity2718 prevalence was 0.21% (n  =  329). Most @entity1 (59.7%) received a @entity8509 only; in 33.1% @entity2176 was added, whereas 7.2% received @entity2176 only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased @entity2718 risk (odds ratio, 1.43; confidence interval, 1.07-1.92), whereas no significant associations existed for @entity2176 use as adjuvant or primary prophylactic compared with the use of @entity2886 (odds ratio, 1.21; confidence interval, 0.92-1.60, and odds ratio, 1.39; confidence interval, 0.94-2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5-35.7), use of adjuvant @entity2176 (interquartile range, 4.2-61.1), and @entity2176 alone (interquartile range, 2.3-10.4). CONCLUSIONS: Although extended use of antibiotic prophylaxis was associated with increased @entity2718 risk after coronary artery bypass grafting, @entity2176 use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce @entity2718 risk.
