The levels of evidence (A-C) and classification of recommendations (I-III) are defined at the end of the "Major Recommendations" field.
Antimicrobial Resistance
Guideline Panel Conclusion: The duration of a prophylactic antibiotic regimen is directly related to the probability of developing resistant microorganisms.
Optimal Practice: The duration of a prophylactic antibiotic regimen is limited to the shortest amount of time required to effectively minimize the probability of postoperative infection. Class IIa. Level B.
Surgical Site Infection
- Chest Tubes and Antibiotic Prophylaxis
- Guideline Panel Conclusion: The duration of antibiotic prophylaxis should not be dependent on indwelling catheters of any type.
- Optimal Practice: Decisions regarding the continuation of antibiotic prophylaxis are not guided by the presence of indwelling catheters. Class IIb. Level C.
- Single-dose prophylaxis
- Guideline Panel Conclusion: Single dose antibiotic prophylaxis may be effective in cardiac surgery, but there are inconclusive data to confirm this effectiveness. There is insufficient evidence to recommend use of single-dose prophylaxis in cardiac surgery.
- Optimal Practice: Single-dose prophylaxis is used in circumstances the surgeon considers optimal for patient care. Class IIa. Level B.
- Prophylaxis for 48 hours
- Guideline Panel Conclusion: Antibiotic prophylaxis of up to 48 hours duration is unlikely to produce antibiotic resistance.
- Guideline Panel Conclusion: Antibiotic prophylaxis of 48 hours duration is clinically effective in minimizing infectious complications in cardiac surgery.
- Guideline Panel Conclusion: Antibiotic prophylaxis of 48 hours duration may be as effective as prophylaxis administered for longer than 48 hours.
Summary Conclusions
There is evidence indicating that antibiotic prophylaxis of 48 hours duration is effective. There is some evidence that single-dose prophylaxis or 24-hour prophylaxis may be as effective as 48-hour prophylaxis, but additional studies are necessary before confirming the effectiveness of prophylaxis lasting less than 48 hours. There is no evidence that prophylaxis administered for longer than 48 hours is more effective than a 48-hour regimen.
Optimal Practice: Antibiotic prophylaxis is not continued for more than 48 hours postoperatively. Class IIa. Level B.
Definitions:
Levels of Evidence
Level A: Data derived from multiple randomized clinical trials
Level B: Data derived from a single randomized trial or from nonrandomized trials
Level C: Consensus expert opinion
Classification of Recommendations
Class I: Conditions for which there is evidence and/or general agreement that a given procedure is useful and effective
Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure
IIa: Weight of evidence favors usefulness/efficacy.
IIb: Usefulness/efficacy is less well established by evidence.
Class III: Conditions for which there is evidence and/or general agreement that the procedure is not useful/effective
