Short-Duration Antibiotic Prophylaxis in the Context of Cardiac Surgery: A Systematic Review and Meta-Analysis

Antibiotic prophylaxis (AP) is crucial in cardiac surgery. Although evidence supports short-duration AP (<48 h), long-duration practice (>48 h) persists. This systematic review with meta-analysis evaluates the protective efficacy of short-duration AP compared to long-duration AP, aiming to optimize postoperative infection prevention. This systematic review and meta-analysis evaluated the efficacy of AP, focusing on duration. Following the PRISMA 2020 checklist and PICO criteria, with protocol registered on the PROSPERO platform (CRD420251071263). Two randomized clinical trials were included, totaling 795 participants (402 in the short-duration group and 393 in the long-duration group) and 92 surgical site infection (SSI) events. The meta package in RStudio was used for meta-analysis. This meta-analysis included two studies (n = 795 patients) comparing reduced (<48 h) versus prolonged (>72 h) antibiotic prophylaxis regimens in cardiac surgery. The random-effects model showed no statistically significant difference in infection risk between groups (RR: 1.47; 95% CI: 0.99–2.18; p = 0.054), with significant homogeneity (I² = 0%, p = 0.387). Study-level analyses showed that only Koudieh et al. (2024) demonstrated increased risk with reduced prophylaxis (RR: 1.60; 95% CI: 1.03–2.47), while Gupta et al. (2010) showed no difference (RR: 1.02; 95% CI: 0.41–2.55). The heterogeneity test (Q = 0.75; p = 0.387) and low I² suggest consistency across studies, although the borderline statistical significance ( p ≈ 0.05) indicates a possible clinical trend favoring prolonged regimens. This meta-analysis found no statistically significant difference in SSI risk between short- and long-duration AP in cardiac surgery, although a marginal trend favoring prolonged prophylaxis was observed (p = 0.054). Heterogeneity was null. Findings suggest that short-duration AP may be a comparable strategy; however, the observed trend and divergent study results indicate the need for more robust evidence to define protocols.