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Preoperative prophylaxis decreased rate of SSIs
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Administering preoperative antibiotic therapy within 2 hours before cardiac surgery significantly decreased the number of surgical site infections, according to research published in Infection Control and Hospital Epidemiology.
“Antimicrobial prophylaxis can reduce the risk of surgical site infections following many operations, however, that efficacy diminishes or disappears if antibiotics are given either too early or after incision,” Renato Finkelstein, MD, of the Israel Institute of Technology and Rambam Medical Center in Haifa, Israel, said in a press release. “Despite the general acceptance of this concept in guidelines, wide variations in preoperative antibiotic administration practices have been reported.”
Renato Finkelstein
Finkelstein and colleagues conducted a prospective cohort study in which they collected data about surgical site infections (SSIs) among cardiac surgery patients from Jan. 1, 1997 to Dec. 31, 2006. They evaluated the effectiveness of several infection control measures, including timing and type of antibiotic prophylaxis. The final analysis included 2,637 operations.
Preoperative prophylaxis (given within 2 hours before incision) was administered before 96.2% of the operations. Among the 101 patients who did not receive preoperative prophylaxis, eight received early prophylaxis (more than 2 hours before the incision) and 92 received postoperative prophylaxis (up to 2 hours after the incision). One patient received prophylaxis more than 2 hours after the incision. Most of the patients received cefazolin (80.5%) and the remainder received vancomycin.
During the 10-year period, there were 222 SSIs among 220 patients, including superficial skin infections in 87 patients and deep/organ space infections in 87 patients. Infection rates were similar for those who received cefazolin or vancomycin. SSIs were less common among those who received preoperative prophylaxis: 8.1% compared with 13.9% of the patients who received prophylaxis at a different time (OR=1.8; 95% CI, 1.0-3.3).
The rate of superficial skin infections was higher in those who did not receive preoperative prophylaxis: 13.9% vs. 4.8% for those who did receive preoperative prophylaxis (OR=3.2; 95% CI, 1.8-5.8). There was no difference in the rates of deep/organ space infections.
In the univariate analysis, a preoperative hospital stay of 5 days or more, an National Nosocomial Infections Surveillance (NNIS) risk index category of 2 or 3, and age 60 years and older were independently associated with higher risk for SSI. On a multivariate analysis, emergency surgery, age, involvement with one of two specific surgeons and administration of nonpreoperative prophylaxis were independent predictors of superficial infection.
“Our infection control program demonstrates the positive collaboration surgeons and infection control personnel can have to improve patient safety and reduce the risk of postsurgical infection,” Finkelstein said.
Disclosure: The researchers report no relevant disclosures.
Perspective
Back to TopDeborah Yokoe, MD, MPH
The conclusions from this large observational study are consistent with results from previous studies that support the importance of optimizing the timing of perioperative antimicrobial prophylaxis as a strategy to decrease the risk of surgical site infection (SSI). The impact of the timing of the start of antimicrobial prophylaxis on SSI risk has been noted for many types of surgical procedures, including cardiac surgery. Because adequate levels of antimicrobial agents are needed in serum and tissue in order to prevent SSIs, it makes sense that administering antimicrobial treatment too early or too late (i.e., after the procedure has already started) won’t be as effective at decreasing infection risk. This is the basis of the ASHP/SHEA/IDSA/SIS Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery recommendation to administer the first dose of perioperative antimicrobial prophylaxis within 60 minutes before surgical incision or within 120 minutes for agents with longer infusion time such, as vancomycin or fluoroquinolones.
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