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21-03-2013 | Infectious disease | Article

Prophylactic antibiotic timing may not affect surgery infection risk

Abstract

Free abstract

medwireNews: The timing of prophylactic antibiotic administration does not appear to influence a patient's risk for surgical site infection (SSI), say US researchers.

No significant difference was seen in rates of SSI among patients (92% male) undergoing orthopedic, colorectal, vascular, or gynecologic surgery, who were given prophylactic antibiotics before (n=31,692) or after (n=767) the first surgical incision was made.

But the type of antibiotic used was found to influence SSI risk, say Mary Hawn (University of Alabama at Birmingham) and co-investigators. In patients undergoing orthopedic procedures, the use of vancomycin on its own was associated with a 75% higher SSI risk compared with cefazolin alone.

Among patients having colorectal surgery, the risk for SSI was 51% lower with combined cefazolin plus an anerobic agent and 45% lower with quinolone plus an anaerobic antibiotic, compared with cefoxitin alone.

In light of these findings, the researchers advise: "Future endeavors for reducing SSI should robustly correlate with improved outcomes and include studies to refine recommended antibiotic choice and redosing."

As reported in JAMA Surgery, Hawn and team analyzed data taken from the National Veterans Affairs Surgical Care Improvement Project (involving 112 Veterans Affairs hospitals in the USA) and the matched Veterans Affairs Surgical Quality Improvement Program.

A total of 32,459 operations were reviewed, revealing that prophylactic antibiotics were given at a median time of 28 minutes before creation of the first surgical incision. In all, 1497 (4.6%) patients developed a SSI.

Despite the observations made, editorialist Leigh Neumayer (University of Utah, Salt Lake City, USA) warns that the findings are "not a call to abandon prophylactic antibiotics when indicated, as most studies have shown a significant reduction in postoperative surgical site infections with their use (when compared with no antibiotics).

"However, it does once again strongly suggest that the current publicly reported measures are not associated with improved outcomes."

Also, Hawn and co-researchers caution that as the data analyzed were obtained primarily from male patients the findings may not apply to women undergoing surgery.

By Lauretta Ihonor, medwireNews reporter

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