Prevention of Infections in Cardiac Surgery: a Cluster-randomized Factorial Cross-over Trial
Overview
- Phase
- Not Applicable
- Intervention
- Cefazolin
- Conditions
- Thoracic Surgery
- Sponsor
- Hamilton Health Sciences Corporation
- Enrollment
- 5989
- Locations
- 4
- Primary Endpoint
- Proportion of patients receiving antibiotics according to study protocol
- Status
- Terminated
- Last Updated
- last year
Overview
Brief Summary
There is clinical equipoise about the question of whether antibiotic prophylaxis should be given for a short period or an extended period of time as reflected by inconsistencies in major guidelines, current practices at Canadian centers, and as concluded in the three systematic reviews. There also is clinical equipoise on whether the addition of vancomycin to routine cefazolin prophylaxis can further reduce s-SSI rates. A short duration of combined antimicrobial prophylaxis can reduce side effects of exposure to antimicrobials such as infections with C. difficile or emergence of resistance, but may also reduce the incidence of s-SSIs. The objective of the eventual full scale study is to determine whether adding vancomycin to cefazolin can reduce SSIs as well as whether short-term prophylaxis is as effective as long-term prophylaxis. The rationale to conduct the proposed pilot study is to assess the feasibility to conduct this factorial cluster randomized cross-over trial, the adherence to the study protocol at each pilot site, the length of time to fill out the case report forms, and to get reliable estimates of event rates for sample size calculation for the main study
Investigators
Dominik Mertz
Assistant Professor, Medical Director Infection Prevention and Control
Hamilton Health Sciences Corporation
Eligibility Criteria
Inclusion Criteria
- •All adult patients (≥18 years of age) undergoing open-heart surgery (sternotomy, including minimally-invasive surgical techniques).
Exclusion Criteria
- •Patients on antibiotics at the time of surgery.
- •Previous enrollment in this trial.
- •Known MRSA carriers. Beta-lactam allergy (IgE-mediated) precluding the use of cefazolin
- •Participant in another study that may interfere with this trial.
Arms & Interventions
Cefazolin monotherapy, short course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered
Intervention: Cefazolin
Cefazolin monotherapy, long course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered followed by additional five doses every eight hours postoperatively (last dose 44 hours after the first dose).
Intervention: Cefazolin
Combination therapy, short course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered. In addition, one dose of vancomycin 60-90min pre-op will be administered.
Intervention: Cefazolin
Combination therapy, short course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered. In addition, one dose of vancomycin 60-90min pre-op will be administered.
Intervention: Vancomycin
Combination therapy, long course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered followed by additional five doses every eight hours postoperatively (last dose 44 hours after the first dose). In addition, one dose of vancomycin 60-90min pre-op will be administered followed by 3 post-op doses every 12 hours (last dose 36 hours after first dose)
Intervention: Cefazolin
Combination therapy, long course
One pre-op dose of cefazolin 30-60 minutes prior to surgery followed by a second dose either four hours after the first dose or upon wound closure (whatever comes first) will be administered followed by additional five doses every eight hours postoperatively (last dose 44 hours after the first dose). In addition, one dose of vancomycin 60-90min pre-op will be administered followed by 3 post-op doses every 12 hours (last dose 36 hours after first dose)
Intervention: Vancomycin
Outcomes
Primary Outcomes
Proportion of patients receiving antibiotics according to study protocol
Time Frame: 3 months post-surgery
Co-Primary outcome of pilot study
Proportion of patients with complete follow-up, i.e. up to 90 days or death; goal >95%
Time Frame: 3 months post-surgery
Co-Primary outcome of pilot study
Agreement of blinded outcome assessment based on information from the case report form
Time Frame: 3 months post-surgery
Co-Primary outcome of pilot study
Secondary Outcomes
- Deep incisional and organ/space sternal surgical site infection (NHSN/CDC)(3 months post-surgery)
- Clostridium difficile infection(3 months post-surgery)
- All types of sternal surgical site infection (superficial, deep, organ; NHSN/CDC)(3 months post-surgery)
- Mortality(3 months post-surgery)