{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:06:01Z","timestamp":1788930361686,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Infections following cardiac surgery are a significant cause of morbidity and mortality, particularly in intensive care units (ICUs). The role of antibiotic prophylaxis (AP) in preventing surgical site infections (SSIs) and other nosocomial infections is crucial; however, the optimal approach to agent selection, dosing, and duration remains controversial. Objective: This narrative review aims to summarise the current evidence and expert recommendations regarding the use of perioperative antibiotic prophylaxis (AP) in adults undergoing cardiac surgery, with a particular focus on intensive care settings, transplant recipients, and adult patients on extracorporeal membrane oxygenation (ECMO). Methods: A comprehensive review of recent literature was conducted, focusing on pharmacokinetic\/pharmacodynamic (PK\/PD) principles, microbial epidemiology, antimicrobial resistance (AMR), and practical strategies for tailored prophylaxis in high-risk populations. Results: Cefazolin remains the first-line agent for most procedures, with vancomycin or clindamycin reserved for patients who are allergic to \u03b2-lactams or who are colonised with MRSA. Redosing is recommended in cases of prolonged surgery or cardiopulmonary bypass. Evidence supports limiting prophylaxis to \u226424 h, with a potential extension to 48 h in select high-risk cases; however, continuation beyond this is discouraged due to the risk of resistance. In heart transplantation, multimodal prophylaxis against bacteria, fungi, and viruses is essential but must be tailored to the individual patient. In the ECMO setting, the current evidence does not support the routine administration of prophylaxis (AP), and therapy should be tailored based on pharmacokinetics (PK)\/pharmacodynamics (PD) changes and the clinical context. A multidisciplinary, evidence-based approach to AP in cardiac surgery is essential. Prophylaxis should be patient-specific, microbiologically guided, and limited in duration to reduce the emergence of multidrug-resistant organisms. Integrating antimicrobial stewardship, non-pharmacological measures, and rigorous surveillance is crucial for optimising the prevention of infections in this vulnerable population.<\/jats:p>","DOI":"10.3390\/antibiotics14090934","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:59:51Z","timestamp":1758088791000},"page":"934","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Length and Type of Antibiotic Prophylaxis for Infection Prevention in Adults Patient in the Cardiac Surgery Intensive Care Unit: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8729-655X","authenticated-orcid":false,"given":"Raffaele","family":"Barbato","sequence":"first","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4801-0005","authenticated-orcid":false,"given":"Benedetto","family":"Ferraresi","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Chello","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3505-1153","authenticated-orcid":false,"given":"Alessandro","family":"Strumia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Gagliardi","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Loreni","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-6121","authenticated-orcid":false,"given":"Alessia","family":"Mattei","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4913-9834","authenticated-orcid":false,"given":"Giuseppe","family":"Santarpino","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University \u201cMagna Gr\u00e6cia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Carassiti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Grigioni","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Science, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0982-0550","authenticated-orcid":false,"given":"Mario","family":"Lusini","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e24162","DOI":"10.1097\/MD.0000000000024162","article-title":"Clinical investigation of nosocomial infections in adult patients after cardiac surgery","volume":"100","author":"Liu","year":"2021","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/j.athoracsur.2016.12.041","article-title":"Healthcare-associated infections in cardiac surgery patients with prolonged intensive care unit stay","volume":"103","author":"Mazzeffi","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","first-page":"233","article-title":"Perioperative antibiotic prophylaxis\u2014indications and modalities for the prevention of postoperative wound infection","volume":"121","author":"Eckmann","year":"2024","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.athoracsur.2005.06.034","article-title":"The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic prophylaxis in cardiac surgery\u2014Part I: Duration","volume":"81","author":"Edwards","year":"2006","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.athoracsur.2006.09.046","article-title":"The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, Part II: Antibiotic choice","volume":"83","author":"Engelman","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/ACO.0000000000000097","article-title":"Important issues for perioperative systemic antimicrobial prophylaxis in surgery","volume":"27","author":"Sinha","year":"2014","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/jac\/dkr470","article-title":"Antibiotic prophylaxis in cardiac surgery: Systematic review and meta-analysis","volume":"67","author":"Lador","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13019-015-0225-x","article-title":"Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: An observational study","volume":"10","author":"Hamouda","year":"2015","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"948","DOI":"10.3109\/00365548.2012.700118","article-title":"Surgical site infection prophylaxis strategies for cardiothoracic surgery: A decision-analytic model","volume":"44","author":"Kaye","year":"2012","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jhin.2018.05.026","article-title":"Prevention of deep sternal wound infection in cardiac surgery: A literature review","volume":"100","author":"Vos","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_12","first-page":"345","article-title":"Antimicrobial formulation and delivery in the prevention of surgical site infection","volume":"17","author":"Itani","year":"2016","journal-title":"Surg. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jacc.2014.10.028","article-title":"Infections following cardiac surgery: An opportunity for clarity","volume":"65","author":"Badhwar","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Parmanik, A., Das, S., Kar, B., Bose, A., Dwivedi, G.R., and Pandey, M.M. (2022). Current treatment strategies against multidrug-resistant bacteria: A review. Curr. Microbiol., 79.","DOI":"10.1007\/s00284-022-03061-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"686","DOI":"10.4065\/mcp.2011.0012","article-title":"Antimicrobial prophylaxis in adults","volume":"86","author":"Enzler","year":"2011","journal-title":"Mayo Clin. Proc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.jtcvs.2012.01.087","article-title":"When the timing is right: Antibiotic timing and infection after cardiac surgery","volume":"144","author":"Koch","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_17","first-page":"520","article-title":"Nosocomial infections in adults receiving extracorporeal membrane oxygenation","volume":"75","author":"Nair","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12896","DOI":"10.1111\/tid.12896","article-title":"Cytomegalovirus infection in heart transplantation: A single center experience","volume":"20","author":"Echenique","year":"2018","journal-title":"Transpl. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e284","DOI":"10.1097\/TP.0000000000003307","article-title":"Recent trends of infectious complications following heart transplantation","volume":"104","author":"Multani","year":"2020","journal-title":"Transplantation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e01360-18","DOI":"10.1128\/AAC.01360-18","article-title":"Antimicrobial prophylaxis for patients undergoing cardiac surgery: Intraoperative cefazolin concentrations and sternal wound infections","volume":"62","author":"Zelenitsky","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e00440","DOI":"10.1002\/prp2.440","article-title":"Effects of cardiopulmonary bypass on the disposition of cefazolin in patients undergoing cardiothoracic surgery","volume":"6","author":"Asada","year":"2018","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1086\/421095","article-title":"Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project","volume":"38","author":"Bratzler","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jvn.2014.01.003","article-title":"The predictors of surgical site infection post cardiac surgery: A systematic review","volume":"32","author":"Musallam","year":"2014","journal-title":"J. Vasc. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.cvsm.2015.01.006","article-title":"Antimicrobial considerations in the perioperative patient","volume":"45","author":"Boothe","year":"2015","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1016\/j.transproceed.2017.09.020","article-title":"Perioperative prophylaxis for total artificial heart transplantation","volume":"49","author":"Chambers","year":"2017","journal-title":"Transplant. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1089\/sur.2018.272","article-title":"Antibiotic prophylaxis in pediatric cardiac surgery: Where are we and where do we go? A systematic review","volume":"20","author":"Jaworski","year":"2019","journal-title":"Surg. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/MAT.0000000000000287","article-title":"The evidence base for prophylactic antibiotics in patients receiving extracorporeal membrane oxygenation","volume":"62","author":"Cawcutt","year":"2016","journal-title":"ASAIO J."},{"key":"ref_28","first-page":"324","article-title":"In-hospital post-operative infection after heart transplantation: Incidence, risk factors, and prognostic impact","volume":"40","author":"Lemaignen","year":"2021","journal-title":"J. Heart Lung Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1186\/s13054-024-04999-9","article-title":"Gut colonization with multidrug resistant organisms in the intensive care unit: A systematic review and meta-analysis","volume":"28","author":"Heath","year":"2024","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/j.1600-0463.2007.00834.x","article-title":"Antibiotic prophylaxis in cardiac surgery\u2014General principles","volume":"115","author":"Friberg","year":"2007","journal-title":"APMIS"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1177\/1757177420971850","article-title":"Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland","volume":"22","author":"Ackah","year":"2021","journal-title":"J. Infect. Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.thorsurg.2011.08.012","article-title":"Perioperative antibiotics in thoracic surgery","volume":"22","author":"Chang","year":"2012","journal-title":"Thorac. Surg. Clin."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"391","DOI":"10.2217\/fmb.14.146","article-title":"Fighting antibiotic resistance in the intensive care unit using antibiotics","volume":"10","author":"Plantinga","year":"2015","journal-title":"Future Microbiol."},{"key":"ref_34","first-page":"6S","article-title":"Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO","volume":"40","author":"Marcus","year":"2025","journal-title":"Perfusion"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1146\/annurev.biochem.78.082907.145923","article-title":"Multidrug resistance in bacteria","volume":"78","author":"Nikaido","year":"2009","journal-title":"Annu. Rev. Biochem."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.cmi.2022.12.012","article-title":"ESCMID\/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery","volume":"29","author":"Righi","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103760","DOI":"10.1016\/j.iccn.2024.103760","article-title":"Risk factors for colonisation by multidrug-resistant bacteria in critical care units","volume":"86","author":"Guerrero","year":"2025","journal-title":"Intens. Crit. Care Nurs."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jhin.2007.08.010","article-title":"Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery","volume":"68","author":"Hortal","year":"2008","journal-title":"J. Hosp. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mattei, A., Cuccarelli, M., Schiavoni, L., Nenna, A., Pascarella, G., Ruggiero, A., Carpinteri, L., Costa, F., Lusini, M., and Mastroianni, C. (2024). Role of preoperative multiple-drug-resistant bacteria intestinal colonization in cardiac surgery: A retrospective study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226897"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ejcts.2010.05.043","article-title":"Should cardiac surgery be delayed among carriers of methicillin-resistant Staphylococcus aureus to reduce methicillin-resistant Staphylococcus aureus-related morbidity by preoperative decolonisation?","volume":"39","author":"Healy","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/934\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:33Z","timestamp":1760035593000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["antibiotics14090934"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14090934","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]}}}