Study: Higher cefazolin dose does not reduce SSIs among obese patients
Key takeaways:
- During the study, 63% of elective colorectal surgery patients received 3 g cefazolin instead of a 2 g dose.
- The increased dose was not associated with decreased SSIs in the study population.
A higher cefazolin dose was not associated with decreased rates of surgical site infections among obese patients undergoing elective colorectal surgery, study data showed.
“Our research team has been fortunate to work with the Michigan Surgical Quality Collaborative’s (MSQC) large, validated database of elective colorectal surgeries in Michigan. This question on the impact of 3 g vs. 2 g cefazolin dosing in patients with obesity developed out of our own curiosity,” Curtis D. Collins, PharmD, MS, BCPS, BCIDP, FASHP, pharmacy specialist of infectious diseases at Trinity Health Ann Arbor, told Healio.
“How were we doing on the overall compliance with dosing recommendations statewide and what exactly is the impact on surgical site infections (SSIs) from this long-standing guideline recommendation? There are very limited data supporting guideline recommendations, and we felt an opportunity existed to investigate this important question utilizing the MSQC database,” he said.
The researchers conducted a multicenter, retrospective cohort study using a database of elective colorectal surgeries at Michigan acute-care hospitals performed on adult patients weighing 120 kg or more who received cefazolin and metronidazole for surgical prophylaxis between July 2012 and June 2021.
The primary outcome was SSIs diagnosed within 30 days of the procedure. According to the study, the researchers then used multivariable logistic regression to identify factors associated with SSIs.
Ultimately, 581 patients were included in the study, of whom 367 (63.1%) received cefazolin 3 g and 214 (36.8%) received 2 g. Data showed that fewer patients who received cefazolin 3 g had optimal antibiotic timing — defined as initiation of all doses of cefazolin and metronidazole prophylaxis within 1 hour before incision — (n = 324; 88.3% vs. n = 200; 93.5%; P = .043), as well as an increased likelihood of receiving prophylaxis antibiotics after incision (n = 22; 6% vs. n = 5; 2.3%; P = .043).
They added, though, that there was no significant difference in SSIs between the 3 g and 2 g cohorts (n = 23; 6.3% vs. n = 16; 7.5%; P = .574), leading the researchers to conclude that cefazolin 3 g was not associated with decreased SSIs in patients with obesity undergoing elective colorectal surgery.
“It’s important to note that the study was underpowered; however, to our knowledge this is the largest study investigating this important question to date,” Collins said. “Given the operational challenges of 3 g dosing and limited data supporting this recommendation, we hope our study provides value for decision-makers in the future.”
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