Grant: Project Grant

Despite routine use of antibiotic before and after surgery ("antibiotic prophylaxis") and many other steps that are taken for prevention of infections during surgery, infections of the chest wound remain a common, potentially deadly but preventable complication of heart surgery. Antibiotic prophylaxis is considered the most important means to prevent this infection. However, the best duration and choice of antibiotic prophylaxis in patient undergoing open heart surgery is still unclear, and there is a large variability in what is currently being done. Despite the lack of convincing evidence and guidelines discouraging prolonged antibiotic prophylaxis and the risks associated with unnecessary use of antibiotics such as emergence of "superbugs", long-term prophylaxis is still common in most Canadian cardiac surgery centers, and around the world. We propose a multi-centre trial to identify the best duration and choice of antibiotic prophylaxis regimens to reduce chest wound infections. The proposed study will be conducted at 24 Canadian and non-Canadian sites using four different prophylactic strategies to be implemented for a 6 months period each with the order of the treatments being randomized. The feasibility of the trial design is being assessed in our pilot/vanguard study with a total of 6,000 patients enrolled. Our data to date shows feasibility of the proposed study and we have identified centers that would be willing to participate in the full trial if funding becomes available. The findings would have major implications on the care of patients undergoing heart surgery worldwide and potentially prevent thousands of severe infections and deaths while ensuring responsible use of antibiotics.