Antimicrobial prophylaxis may not be the answer: Surgical site infections among patients receiving care per recommended guidelines

Francesca M. Lee, Sylvia Trevino, Emily Kent-Street, Pranavi Sreeramoju

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8 Citations (Scopus)

Abstract

Background: It is believed that compliance with all 3 components of perioperative antimicrobial prophylaxis, ie, timing, choice, and duration, yields greater reduction in surgical site infections (SSI). Methods: An observational study was performed among patients in the surgical care improvement project at a tertiary public academic hospital in the United States. The rates of SSI among patients who received appropriate antimicrobial agent(s) per current guidelines were compared with patients who did not. Medical record review was performed to compare the clinical characteristics of patients with SSI (cases) and an equal number of patients without SSI (matched controls). Results: From January 2008 to June 2009, 762 patients underwent 763 eligible surgical procedures. Forty-seven (6.2%) developed SSI. The rate of SSI in patients who received appropriate antimicrobial prophylaxis per guidelines was not different from those who did not (42/611, 6.9% vs 5/152, 3.3%, respectively; P value =.13). Patients with SSI were more likely to have an elevated body mass index (median and interquartile range in cases: 28.7 [27.0-34.9] vs 25.0 [22.4-30.4] in controls; P value =.02) and more likely to have diabetes (36% vs 9%, respectively; odds ratio, 5.71; 95% confidence interval: 1.43-22.8; P value =.02). Conclusion: Compliance with timing, choice, and duration of antimicrobial prophylaxis as a whole did not lead to lower SSI. Elevated body mass index and diabetes were associated with a higher rate of SSI.

Original languageEnglish (US)
Pages (from-to)799-802
Number of pages4
JournalAmerican Journal of Infection Control
Volume41
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Surgical Wound Infection
Patient Care
Guidelines
Body Mass Index
Public Hospitals
Infection Control
Anti-Infective Agents
Tertiary Care Centers
Medical Records
Observational Studies
Odds Ratio
Confidence Intervals

Keywords

  • Infection control
  • Observational study
  • Perioperative care
  • Surgical wound infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Health Policy

Cite this

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title = "Antimicrobial prophylaxis may not be the answer: Surgical site infections among patients receiving care per recommended guidelines",
abstract = "Background: It is believed that compliance with all 3 components of perioperative antimicrobial prophylaxis, ie, timing, choice, and duration, yields greater reduction in surgical site infections (SSI). Methods: An observational study was performed among patients in the surgical care improvement project at a tertiary public academic hospital in the United States. The rates of SSI among patients who received appropriate antimicrobial agent(s) per current guidelines were compared with patients who did not. Medical record review was performed to compare the clinical characteristics of patients with SSI (cases) and an equal number of patients without SSI (matched controls). Results: From January 2008 to June 2009, 762 patients underwent 763 eligible surgical procedures. Forty-seven (6.2{\%}) developed SSI. The rate of SSI in patients who received appropriate antimicrobial prophylaxis per guidelines was not different from those who did not (42/611, 6.9{\%} vs 5/152, 3.3{\%}, respectively; P value =.13). Patients with SSI were more likely to have an elevated body mass index (median and interquartile range in cases: 28.7 [27.0-34.9] vs 25.0 [22.4-30.4] in controls; P value =.02) and more likely to have diabetes (36{\%} vs 9{\%}, respectively; odds ratio, 5.71; 95{\%} confidence interval: 1.43-22.8; P value =.02). Conclusion: Compliance with timing, choice, and duration of antimicrobial prophylaxis as a whole did not lead to lower SSI. Elevated body mass index and diabetes were associated with a higher rate of SSI.",
keywords = "Infection control, Observational study, Perioperative care, Surgical wound infection",
author = "Lee, {Francesca M.} and Sylvia Trevino and Emily Kent-Street and Pranavi Sreeramoju",
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AU - Trevino, Sylvia

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AU - Sreeramoju, Pranavi

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N2 - Background: It is believed that compliance with all 3 components of perioperative antimicrobial prophylaxis, ie, timing, choice, and duration, yields greater reduction in surgical site infections (SSI). Methods: An observational study was performed among patients in the surgical care improvement project at a tertiary public academic hospital in the United States. The rates of SSI among patients who received appropriate antimicrobial agent(s) per current guidelines were compared with patients who did not. Medical record review was performed to compare the clinical characteristics of patients with SSI (cases) and an equal number of patients without SSI (matched controls). Results: From January 2008 to June 2009, 762 patients underwent 763 eligible surgical procedures. Forty-seven (6.2%) developed SSI. The rate of SSI in patients who received appropriate antimicrobial prophylaxis per guidelines was not different from those who did not (42/611, 6.9% vs 5/152, 3.3%, respectively; P value =.13). Patients with SSI were more likely to have an elevated body mass index (median and interquartile range in cases: 28.7 [27.0-34.9] vs 25.0 [22.4-30.4] in controls; P value =.02) and more likely to have diabetes (36% vs 9%, respectively; odds ratio, 5.71; 95% confidence interval: 1.43-22.8; P value =.02). Conclusion: Compliance with timing, choice, and duration of antimicrobial prophylaxis as a whole did not lead to lower SSI. Elevated body mass index and diabetes were associated with a higher rate of SSI.

AB - Background: It is believed that compliance with all 3 components of perioperative antimicrobial prophylaxis, ie, timing, choice, and duration, yields greater reduction in surgical site infections (SSI). Methods: An observational study was performed among patients in the surgical care improvement project at a tertiary public academic hospital in the United States. The rates of SSI among patients who received appropriate antimicrobial agent(s) per current guidelines were compared with patients who did not. Medical record review was performed to compare the clinical characteristics of patients with SSI (cases) and an equal number of patients without SSI (matched controls). Results: From January 2008 to June 2009, 762 patients underwent 763 eligible surgical procedures. Forty-seven (6.2%) developed SSI. The rate of SSI in patients who received appropriate antimicrobial prophylaxis per guidelines was not different from those who did not (42/611, 6.9% vs 5/152, 3.3%, respectively; P value =.13). Patients with SSI were more likely to have an elevated body mass index (median and interquartile range in cases: 28.7 [27.0-34.9] vs 25.0 [22.4-30.4] in controls; P value =.02) and more likely to have diabetes (36% vs 9%, respectively; odds ratio, 5.71; 95% confidence interval: 1.43-22.8; P value =.02). Conclusion: Compliance with timing, choice, and duration of antimicrobial prophylaxis as a whole did not lead to lower SSI. Elevated body mass index and diabetes were associated with a higher rate of SSI.

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