Are cephalosporins adequate for antimicrobial prophylaxis for cardiac surgery involving implants?

Abstract

Sir—We believe that Bratzler et al. [1] should include in the Surgical Infection Prevention (SIP) guidelines the recommendation of vancomycin as an option for antibiotic prophylaxis for cardiac and vascular surgery involving implantation of prosthetic valves or other foreign materials. In patients who undergo cardiac surgery, coagulase-negative strains and coagulase-positive strains of Staphylococcus are the major cause of deep surgical-site infections (SSIs) and postoperative prosthetic-valve endocarditis. In many hospitals, 70%–80% of coagulase-negative and 40%–50% of coagulase-positive Staphylococcus strains are methicillin resistant. Currently, only cephalosporins, which lack activity against methicillin-resistant organisms, are listed in the SIP guidelines for routine prophylaxis for all cardiac surgeries.