PROPHYLACTIC ANTIBIOTIC USE IN PEDIATRIC CARDIOVASCULAR-SURGERY - A SURVEY OF CURRENT PRACTICE

There is little information on prophylactic antibiotic practice in ped iatric cardiovascular surgery, A consensus prophylactic antibiotic pra ctice, if identified, might serve as a Standard to which alternative p rophylactic antibiotic practice could be compared. We surveyed North A merican academic centers with pediatric cardiovascular surgery program s regarding their standard antimicrobial prophylaxis regimens, duratio n of prophylaxis and modification of prophylaxis for lesion, patient a ge or medical device considerations. Forty-three (81%) of 53 centers r esponded; not all responses were complete, Monotherapy was used by 39 (91%) of 43; 38 (97%) of 39 used a 1st or 2nd generation cephalosporin (cefazolin 24, cefamandole 8, cefuroxime 4, cephapirin 1, unspecified 1) and 1 of 39 used vancomycin. Only 4 (9%) of 43 used 2 antibiotics, Prophylactic antibiotics were started pre- or intraoperatively by 41 of 43 centers and discontinued within 2 days by 25 of 37. Prophylactic antibiotics were often continued while thoracostomy tubes (29 of 43), mediastinal tubes (31 of 43) or transthoracic vascular catheters (22 of 43) were in place, but usually not for endotracheal tubes (6 of 43) , arterial (9 of 43) or percutaneous central venous (13 of 43) cathete rs or temporary pacing wires (6 of 43). Our survey indicates that the consensus prophylactic antibiotic regimen for pediatric cardiovascular surgery is monotherapy with a first or second generation cephalospori n, used for less than or equal to 2 days or until transthoracic medica l devices are removed.