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Antimicrobial Agents and Chemotherapy, February 2008, p. 446-451, Vol. 52, No. 2
0066-4804/08/$08.00+0     doi:10.1128/AAC.00495-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Interrupted Time Series Analysis of Vancomycin Compared to Cefuroxime for Surgical Prophylaxis in Patients Undergoing Cardiac Surgery{triangledown}

K. W. Garey,1,2* D. Lai,3 T. K. Dao-Tran,2 L. O. Gentry,2 L. Y. Hwang,3 and B. R. Davis3

University of Houston College of Pharmacy,1 St. Luke's Episcopal Hospital,2 University of Texas School of Public Health, Houston Texas3

Received 12 April 2007/ Returned for modification 23 May 2007/ Accepted 6 November 2007

The increased incidence of methicillin-resistant Staphylococcus aureus (MRSA), the emergence of community-acquired MRSA, and the continued high incidence of methicillin-resistant Staphylococcus epidermidis have required that certain institutions choose vancomycin for surgical prophylaxis. However, the data supporting the use of vancomycin for surgical prophylaxis are controversial. The purpose of this project was to assess the effect of the change from cefuroxime to vancomycin for surgical site infection (SSI) rates in patients undergoing coronary artery bypass graft (CABG) surgery. The monthly rates of SSIs from 2001 to 2005 were analyzed before and after a change from cefuroxime to vancomycin antibiotic prophylaxis in patients undergoing CABG by using an interrupted time series analysis. Patients who underwent cardiac valve replacement surgery and who had received vancomycin during the entire study period were used as a comparator group. A total of 6,465 patients underwent CABG surgery (n = 4,239) or valve replacement surgery (n = 2,226) during the study period. On average, the monthly SSI incidence rate in patients undergoing CABG surgery decreased by 2.1 cases per 100 surgeries after the switch from cefuroxime to vancomycin (P = 0.042) when patients undergoing valve replacement were used as a comparator group. The change in SSI rates was associated with a decrease in the incidence of infections caused by coagulase-negative Staphylococcus and MRSA isolates, with little change in the incidence of SSIs due to other gram-positive organisms or gram-negative organisms. In institutions with a high incidence of methicillin-resistant Staphylococcus species, this study provides evidence for the clinical efficacy of vancomycin prophylaxis for the prevention of postoperative SSIs in patients undergoing CABG surgery.

* Corresponding author. Mailing address: College of Pharmacy, Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX 77030. Phone: (713) 795-8386. Fax: (713) 795-8383. E-mail: kgarey{at}uh.edu

{triangledown} Published ahead of print on 19 November 2007.

Antimicrobial Agents and Chemotherapy, February 2008, p. 446-451, Vol. 52, No. 2
0066-4804/08/$08.00+0     doi:10.1128/AAC.00495-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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