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TITLE:

RESULTS OF SHORT-TERM VERSUS LONGER-TERM ANTIBIOTIC PROPHYLAXIS (ABP) IN PATIENTS WITH DIABETES MELLITUS ENDURING CORONARY ARTERY BYPASS GRAFT

AUTHORS:

Dr Shahzeb, Dr Manzar Ameen, Dr Muhammad Shoaib Younas

ABSTRACT:

Objective: To compare the results of short-term (24-hour) antibiotic prophylaxis (ABP) in diabetic patients undergoing coronary bypass surgery (CABG) and its impact on the incidence of in-hospital deep Sternal Wound Infection (DSWI) / mediastinum infections. Patients and Method: We conducted a cross-sectional comparative study of 160 diabetic patients undergoing CABG in the Cardiac surgery department of Jinnah Hospital Lahore for one-year duration from May 2019 to May 2020. We compared 80 diabetic patients who had received prophylactic antibiotics for less than 24 hours with 80 other diabetic patients who had received more than 24 hours of prophylactic antibiotics undergoing isolated CABG. Surgical site infection (SSI) was assessed daily during the patient's stay. The diagnosis of the identified SSI was based on fever, pain, redness, discharge, purulent drainage, positive cultures, and marked dehiscence of the wound after sternotomy. Results: The incidence of in-hospital deep wound sternum infections (DSWI) / mediastinitis was 7.50% in the 24-h ABP group, and the difference was statistically significant (p = 0.042). The proportion of patients with deep end organ involvement (mediastinitis) and sepsis requiring cable replacement was in 7 patients (8.75%) for 24 hours ABP (P = 0.030). Similar results were observed in terms of mortality (8.75% vs 1.25%). However, the isolated microorganisms showed a similar distribution in both groups. Morbidity, infections, and complex outcomes were more common in patients with diabetes. Conclusions: Diabetes mellitus is an important risk factor of mortality and morbidity among people undergoing CABG. The present study documents a higher incidence of deep sternal wound infections (DSWI) / mediastinitis associated with ABP therapy lasting less than 24 hours, suggesting the need for prolonged ABP in diabetic patients undergoing CABG. Keywords: antibiotic prophylaxis, coronary artery bypass graft, diabetes, surgical site infections

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