Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2024; 13(3): 92658
Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.92658
Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure
Mahmoud Ismail Allam Eissa, Rasha Kaddoura, Danial Hassan, Cornelia S Carr, Samy Hanoura, Yasser Shouman, Abdulwahid Almulla, Amr Salah Omar
Mahmoud Ismail Allam Eissa, Cornelia S Carr, Yasser Shouman, Abdulwahid Almulla, Amr Salah Omar, Department of Cardiothoracic Surgery, Hamad Medical Cooperation, Doha 3050, Qatar
Mahmoud Ismail Allam Eissa, Samy Hanoura, Department of Anesthesia and Intensive Care, Al-Azhar University, Cairo 11651, Egypt
Rasha Kaddoura, Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Danial Hassan, Department of Healthcare Profession, Harvard TH Chan School of Public Health, Ministry of Public Health, Boston, MA 3050, United States
Cornelia S Carr, Department of Surgery, Qatar University, Doha 3050, Qatar
Samy Hanoura, Department of Cardiac Anesthesia, Hamad Medical Corporation, Doha 3050, Qatar
Samy Hanoura, Department of Anesthesia, Weill Cornell Medical College in Qatar, Doha 3050, Qatar
Amr Salah Omar, Department of Critical Care Medicine, Beni Suef University, Beni Suef 62521, Egypt
Amr Salah Omar, Department of Medicine, Weill Cornell Medical College in Qatar, Doha 3050, Qatar
Author contributions: Eissa MIA contributed to data collection, data entry, and manuscript management; Kaddoura R contributed to statistical analysis, critical revision, and writing; Hussien D contributed to data collection; Carr CS coined the research concept, provided methodological support, and contributed to the final revision; Hanoura S and Shouman Y contributed to data collection and data entry; Almulla A contributed to general support and final revision; Omar AS designed the research and contributed to conceptualization, writing, and review.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hamad Medical Corporation.
Informed consent statement: A waiver of informed consent was obtained as the study was a retrospective design.
Conflict-of-interest statement: The authors declare that have no financial relationships to disclose.
Data sharing statement: Data sharing according to the institution rules.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amr Salah Omar, MD, PhD, Professor, Department of Cardiothoracic Surgery, Hamad Medical Cooperation, Alryan Road, Doha 3050, Qatar. a_s_omar@yahoo.com
Received: February 5, 2024
Revised: May 4, 2024
Accepted: May 29, 2024
Published online: September 9, 2024
Processing time: 206 Days and 18.6 Hours
Abstract
BACKGROUND

Delayed sternal closure (DSC) can be a lifesaving approach for certain patients who have undergone cardiac surgery. The value of the type of prophylactic antibiotics in DSC is still debatable.

AIM

To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.

METHODS

This was a retrospective observational single-center study. Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included. Patients were subjected to two regimens of antibiotics: Narrow-spectrum and broad-spectrum regimens.

RESULTS

The main outcome measures were length of hospital and intensive care unit (ICU) stay, duration of mechanical ventilation, and mortality. Of the 53 patients, 12 (22.6%) received narrow-spectrum antibiotics, and 41 (77.4%) received broad-spectrum antibiotics. The mean age was 59.0 ± 12.1 years, without significant differences between the groups. The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrow-spectrum group (11.9 ± 8.7 vs 3.4 ± 2.0 d , P < 0.001). The median duration of open chest was 3.0 (2.0-5.0) d for all patients, with no difference between groups (P = 0.146). The median duration of mechanical ventilation was significantly longer in the broad-spectrum group [60.0 (Δ interquartile range (IQR) 170.0) h vs 50.0 (ΔIQR 113.0) h, P = 0.047]. Similarly, the median length of stay for both ICU and hospital were significantly longer in the broad-spectrum group [7.5 (ΔIQR 10.0) d vs 5.0 (ΔIQR 5.0) d, P = 0.008] and [27.0 (ΔIQR 30.0) d vs 19.0 (ΔIQR 21.0) d, P = 0.031]. Five (9.8%) patients were readmitted to the ICU and 18 (34.6%) patients died without a difference between groups.

CONCLUSION

Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration, length of ICU and hospital stays vs narrow-spectrum antibiotics.

Keywords: Cardiac surgery; Delayed sternal closure; Intensive care; Open chest; Prophylactic antibiotics

Core Tip: In cardiac surgical patients with delayed sternal closure the use of prophylactic broad-spectrum antibiotics did not affect the clinical outcomes in terms of length of mechanical ventilation and length of intensive care stay.