Vancomycin with beta-lactam reduces SSI, ups AKI risk after cardiac surgery
Combination prophylaxis with vancomycin and beta-lactam reduces surgical site infections (SSIs) in cardiac surgery patients better than either antimicrobial alone, a new retrospective cohort study shows. However, combination prophylaxis also increases the risk of postoperative acute kidney injury (AKI).
Participants who underwent hysterectomy (n=1,724), colorectal (n=7,337), vascular (n=7,405), orthopaedic joint replacement (n=33,848) and cardiac (n=19,787) procedures were recruited and further stratified according to prophylaxis received: vancomycin alone, beta-lactam alone or combination.
SSI, 7-day incidence of postoperative AKI and 90-day incidence of Clostridium difficile infection (CDI) were compared among the three groups.
SSI was detected in 0.95 percent (n=66) of cardiac surgery patients who received combination prophylaxis. In comparison, 1.48 percent (n=190) of patients receiving single-agent prophylaxis developed SSI.
The risk of postoperative SSI in cardiac surgery was lower after receiving combination prophylaxis (adjusted risk ratio [aRR], 0.61; 95 percent CI, 0.46 to 0.83). SSI risk was also lower with combination prophylaxis than with beta-lactam (aRR, 0.61; 0.45 to 0.83) or vancomycin (aRR, 0.65; 0.43 to 0.99) alone.
On the other hand, combination prophylaxis was not associated with significantly reduced SSI in the other types of surgeries.
Of the 12,508 participants who received combination prophylaxis, 0.72 percent (n=90) developed CDI. In comparison, 0.81 percent (n=486) of participants who received a single agent developed CDI. There was no association between CDI and combination prophylaxis (aRR, 1.01; 0.78 to 1.31).
Combination prophylaxis was associated with elevated risks of AKI 7 days after orthopaedic joint replacement (aRR, 1.12; 1.02 to 1.23) and vascular surgery (aRR, 1.25 1.04 to 1.50) compared with either beta-lactam or vancomycin alone.