TY - JOUR
T1 - Glycopeptides are no more effective than β-lactam agents for prevention of surgical site infection after cardiac surgery
T2 - A meta-analysis
AU - Bolon, Maureen K.
AU - Morlote, Monica
AU - Weber, Stephen G.
AU - Koplan, Bruce
AU - Carmeli, Yehuda
AU - Wright, Sharon B.
PY - 2004/5/15
Y1 - 2004/5/15
N2 - A meta-analysis was performed to investigate whether a switch from β-lactams to glycopeptides for cardiac surgery prophylaxis should be advised. Results of 7 randomized trials (5761 procedures) that compared surgical site infections (SSIs) in subjects receiving glycopeptide prophylaxis with SSIs in those who received β-lactam prophylaxis were pooled. Neither agent proved to be superior for prevention of the primary outcome, occurrence of SSI at 30 days (risk ratio [RR], 1.14; 95% confidence interval [CI], 0.91-1.42). In subanalyses, β-lactams were superior to glycopeptides for prevention of chest SSIs (RR, 1.47; 95% CI, 1.11-1.95) and approached superiority for prevention of deep-chest SSIs (RR, 1.33; 95% CI, 0.91-1.94) and SSIs caused by gram-positive bacteria (RR, 1.36; 95% CI, 0.98-1.91). Glycopeptides approached superiority to β-lactams for prevention of leg SSIs (RR, 0.77; 95% CI, 0.58-1.01) and were superior for prevention of SSIs caused by methicillin-resistant gram-positive bacteria (RR, 0.54; 95% CI, 0.33-0.90). Standard prophylaxis for cardiac surgery should continue to be β-lactams in most circumstances.
AB - A meta-analysis was performed to investigate whether a switch from β-lactams to glycopeptides for cardiac surgery prophylaxis should be advised. Results of 7 randomized trials (5761 procedures) that compared surgical site infections (SSIs) in subjects receiving glycopeptide prophylaxis with SSIs in those who received β-lactam prophylaxis were pooled. Neither agent proved to be superior for prevention of the primary outcome, occurrence of SSI at 30 days (risk ratio [RR], 1.14; 95% confidence interval [CI], 0.91-1.42). In subanalyses, β-lactams were superior to glycopeptides for prevention of chest SSIs (RR, 1.47; 95% CI, 1.11-1.95) and approached superiority for prevention of deep-chest SSIs (RR, 1.33; 95% CI, 0.91-1.94) and SSIs caused by gram-positive bacteria (RR, 1.36; 95% CI, 0.98-1.91). Glycopeptides approached superiority to β-lactams for prevention of leg SSIs (RR, 0.77; 95% CI, 0.58-1.01) and were superior for prevention of SSIs caused by methicillin-resistant gram-positive bacteria (RR, 0.54; 95% CI, 0.33-0.90). Standard prophylaxis for cardiac surgery should continue to be β-lactams in most circumstances.
UR - http://www.scopus.com/inward/record.url?scp=2442710122&partnerID=8YFLogxK
U2 - 10.1086/383318
DO - 10.1086/383318
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C2 - 15156470
AN - SCOPUS:2442710122
SN - 1058-4838
VL - 38
SP - 1357
EP - 1363
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -