059: Perioperative Antibiotic Prophylaxis in Paediatric Cardiac Surgery – is One Day Sufficient to Prevent Surgical Site Infections?

Statement of Purpose, Innovation or Hypothesis: Perioperative antibiotic prophylaxis (PAbP) is a standard practice in paediatric cardiac surgery to prevent surgical site infections (SSI). Current prophylactic regimens in Germany include cefuroxime (second-generation cephalosporin). The duration of its administration is debated, due to the lack of randomised controlled trials. The target of antibiotic stewardship is to effectively treat infections, prevent antibiotic resistance and to protect patients from unnecessary harm. This study aims at comparing the efficacy of PAbP with cefuroxime during one versus five days perioperatively in children undergoing congenital heart surgery.

Description of Methods & Materials: This retrospective, bi-centre study included patients < 18 years of age undergoing congenital cardiac surgery with cardiopulmonary bypass (CBP) and primary chest closure from 2015 to 2019. Patients with preoperative antibiotic treatment or signs of infection and cases of prior surgeries with CBP during the same admission were excluded. PAbP consisted of cefuroxime, which was administered according to two different regimens based on local guidelines: one day (centre 1) versus five days (centre 2). Patients were stratified according to age and procedural risk (STAT score). The endpoints were the duration of invasive ventilation and the duration of postoperative hospitalisation.

Data & Results: A total number of 305 patients could be included in this analysis so far. Bodyweight (mean 14,0 vs. 16,7 kg, p = 0.074) and STAT score (median 2 vs. 2, p = 0.14) were similar, but the patients were older in centre 2 (median 1,3 vs. 2,5 years, p = 0.04) and mechanical ventilation was longer in center 1 (mean 1,8 vs. 1,7 days, p < 0,01). Mean duration of cefuroxime administration was 3,1 days in centre 1, and 6,3 days in centre 2 (p < 0.01). These results show that the shorter use of cefuroxime is non-inferior and does not cause a significant difference in the duration of postoperative hospitalisation (median 10 vs. 10 days, p = 0.1414).

Interpretation, Conclusion or Significance: According to this retrospective bi-centre study, a one-day PAbP regimen is sufficient to prevent SSI around congenital cardiac surgical procedures. Prospective data should be obtained in a multicentre study to confirm these results

Disclosures: None related to this study

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Additional Information/Authors: None