Mahmoud Ismail Allam Eissa, Rasha Kaddoura, Danial Hassan, Cornelia S Carr, Samy Hanoura, Yasser Shouman, Abdulwahid Almulla, Amr Salah Omar
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Patients were subjected to two regimens of antibiotics: Narrow-spectrum and broad-spectrum regimens.</p><p><strong>Results: </strong>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 <i>vs</i> 3.4 ± 2.0 d , <i>P</i> < 0.001). The median duration of open chest was 3.0 (2.0-5.0) d for all patients, with no difference between groups (<i>P</i> = 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 <i>vs</i> 50.0 (ΔIQR 113.0) h, <i>P</i> = 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 <i>vs</i> 5.0 (ΔIQR 5.0) d, <i>P</i> = 0.008] and [27.0 (ΔIQR 30.0) d <i>vs</i> 19.0 (ΔIQR 21.0) d, <i>P</i> = 0.031]. Five (9.8%) patients were readmitted to the ICU and 18 (34.6%) patients died without a difference between groups.</p><p><strong>Conclusion: </strong>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 <i>vs</i> narrow-spectrum antibiotics.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372511/pdf/","citationCount":"0","resultStr":"{\"title\":\"Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure.\",\"authors\":\"Mahmoud Ismail Allam Eissa, Rasha Kaddoura, Danial Hassan, Cornelia S Carr, Samy Hanoura, Yasser Shouman, Abdulwahid Almulla, Amr Salah Omar\",\"doi\":\"10.5492/wjccm.v13.i3.92658\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>vs</i> 3.4 ± 2.0 d , <i>P</i> < 0.001). The median duration of open chest was 3.0 (2.0-5.0) d for all patients, with no difference between groups (<i>P</i> = 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 <i>vs</i> 50.0 (ΔIQR 113.0) h, <i>P</i> = 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 <i>vs</i> 5.0 (ΔIQR 5.0) d, <i>P</i> = 0.008] and [27.0 (ΔIQR 30.0) d <i>vs</i> 19.0 (ΔIQR 21.0) d, <i>P</i> = 0.031]. 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引用次数: 0
摘要
背景：延迟胸骨闭合术（DSC）可以挽救某些心脏手术患者的生命。目的：研究不同预防性抗生素方案对心脏手术后 DSC 患者的临床效果：这是一项单中心回顾性观察研究。方法：这是一项回顾性观察性单中心研究，共纳入了 53 名连续接受心脏手术并有 DSC 适应症的患者。患者接受了两种抗生素治疗方案：结果：主要结果指标为住院时间、重症监护室（ICU）住院时间、机械通气时间和死亡率。53名患者中，12人（22.6%）使用了窄谱抗生素，41人（77.4%）使用了广谱抗生素。平均年龄为（59.0 ± 12.1）岁，组间无明显差异。广谱组使用抗生素的平均时间明显长于窄谱组（11.9 ± 8.7 对 3.4 ± 2.0 天，P < 0.001）。所有患者的中位开胸时间为 3.0 (2.0-5.0) d，组间无差异（P = 0.146）。广谱组患者机械通气的中位持续时间明显更长[60.0（Δ四分位距（IQR）170.0）小时 vs 50.0（ΔIQR 113.0）小时，P = 0.047]。同样，广谱组患者在重症监护室和医院的中位住院时间也明显更长[7.5 (ΔIQR 10.0) d vs 5.0 (ΔIQR 5.0) d，P = 0.008]和[27.0 (ΔIQR 30.0) d vs 19.0 (ΔIQR 21.0) d，P = 0.031]。5例（9.8%）患者再次入住重症监护室，18例（34.6%）患者死亡，组间无差异：结论：预防性使用广谱抗生素并不能改善心脏手术后 DSC 患者的临床预后，但与窄谱抗生素相比，预防性使用广谱抗生素会延长通气时间、重症监护室和住院时间。
Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure.
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.
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