Why the study?
Does antibiotic prophylaxis with vancomycin plus a beta-lactam alter the risk of surgical site infection, acute kidney injury, and Clostridium difficile infection in cardiac surgery patients compared to either drug alone?
Does antibiotic prophylaxis with vancomycin plus a beta-lactam alter the risk of surgical site infection, acute kidney injury, and Clostridium difficile infection in cardiac surgery patients compared to either drug alone?
In cardiac surgery patients, combination antibiotic prophylaxis with vancomycin and a beta-lactam reduces surgical site infections but increases the risk of acute kidney injury compared to monotherapy.
May reduce SSIs but increase AKI with combination prophylaxis in cardiac surgery; leaves open net benefit pending randomized trials.
There are benefits but also unintended consequences of antimicrobial and infection prevention strategies aimed at "getting to zero" healthcare-associated infections. In our study, combination prophylaxis was associated with both benefits (reduction in SSIs following cardiac surgical procedures) and harms (increase in postoperative AKI). In cardiac surgery patients, the difference in risk-benefit profile by MRSA status suggests that MRSA-screening-directed prophylaxis may optimize benefits while minimizing harms in this selected population. More information about long-term outcomes and patient and societal preferences regarding risk of SSI versus risk of AKI is needed to improve clinical decision-making.
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Branch‐Elliman et al. (2017) studied this question.
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