Adherence to Perioperative Antibiotic Prophylaxis Recommendations and Its Impact on Postoperative Surgical Site Infections

Abstract

Introduction Surgical site infections (SSIs) are common and carry a significant risk of morbidity and mortality and lead to increased healthcare costs. Perioperative antibiotic prophylaxis decreases the risk of SSIs. There are several guidelines on the use of perioperative antibiotic prophylaxis. The American College of Surgeons (ACS) recommends weight-based antibiotic administration within 60 minutes prior to (two hours for vancomycin/fluoroquinolones) incision and redosing by drug half-life. There are limited data regarding adherence to existing recommendations. Furthermore, there are scarce data on the relationship between adherence to recommendations and the risk of postoperative SSI. Objectives In this study, we aimed to assess the adherence to ACS guidelines for perioperative antimicrobial prophylaxis in the Seattle Children’s Hospital (SCH) National Surgical Quality Improvement Program (NSQIP) pediatric cohort and to determine whether adherence to ACS guidelines is associated with a decreased risk of SSI. the secondary objective was to identify risk factors associated with SSI in our patient population. Materials and methods We conducted a secondary analysis of an institutional NSQIP pediatric data cohort between Jan 1, 2012, and Dec 31, 2017. We calculated summary statistics to assess adherence to ACS recommendations and fit a logistic regression model to identify factors associated with the risk of SSI. Patients who did not receive antibiotic prophylaxis were excluded. Results A total of 6,072 surgeries among 5,532 patients met the inclusion criteria. Adherence was achieved for weight-based dosing in 35% of surgeries, administration prior to the incision in 91%, administration within 60 minutes (two hours for vancomycin/fluoroquinolones) in 86%, correct redosing in 97%, and to all recommendations in 29%. There were no significant associations between any adherence metrics and SSI, although confidence intervals were wide for some metrics. Factors associated with SSI when adherence was met included urgent case status, wound class 2 or 4, the American Society of Anesthesiologists (ASA) class 2-5, and surgery duration. Conclusion There was varying adherence to ACS recommendations on antibiotic prophylaxis in our cohort. More evidence is needed to better understand the effects of adherence to any or all components of the recommendations on SSI. We identified a group of pediatric patients at risk of SSI and a need for further research and targeted interventions.

Protocol based Surgical Antimicrobial Prophylaxis in Endo-Urologic Surgeries: An Attempt to Convince the Surgeons to Follow the Guidelines

“…20 Study in Italy found only moderate compliance with this recommendation. 21 Whereas 86% adherence to timing of administration prior to incision was noted in study of Berrondo et al 22 SAP was administered 90 min in Bertschi D et al23, De Jong et al 24 study, and was administered 60 minutes before surgery in Kasatpibal et al 25 and Zhang X et al 26 study, In our study non-compliance in pre-op dose timing was seen in only one unit, that was due to some administrative issues and was later on resolved.…”

“…Poor adherence to antibiotic prophylaxis recommendations has been shown in other studies with similar results. 22,27 We tried to evaluate the reasons for non-compliance and it was noted that knowledge gaps, overcautious attitude of the surgeons, fear of losing faith by the patients, and non-availability of the desired drug in the hospital inventory were few of the reasons for the same. One of the most critical reasons noted was the lack of local evidence from the hospital.…”

Perioperative Antibiotic Prophylaxis in Urological Surgery: An Update Systematic Review

“…Berrondo, et al (2019) 14 showed that there were 65% of patients in the control group demonstrated growth of at least one organism compared to 29% of patients in the antibiotic group. Between three and twelve months following surgery, urine cultures were taken from 124 (74.3%) of the patients during their normal follow-up sessions.…”

“…Seven of nine studies reported UTI rates in their research. 5,9,14,15,[17][18][19] Overall, studies showed lower incidences of UTI in patients receiving antibiotic prophylaxis following the urological surgery. In addition, Nayyar, et al (2023) 17 showed in comparison to patients who got a single-dose antibiotic, postoperative UTI rates were considerably lower in patients who received short-term (1, 2, or 3 days) per-operative prophylaxis.…”

Current state of the use of antibiotic prophylactics in cardiac surgery – correspondence

“…Therefore, practitioners should consider administering shorter antibiotic prophylaxis in cardiac surgery while ensuring appropriate antibiotic stewardship measures are taken. Another study on perioperative antibiotic prophylaxis recommendations in various surgical specialities found that adherence to guidelines is critical in preventing postoperative SSI 5 .…”