Activity of Commonly Used Antimicrobial Prophylaxis Regimens against Pathogens Causing Coronary Artery Bypass Graft and Arthroplasty Surgical Site Infections in the United States, 2006–2009

Background.Coronary artery bypass graft (CABG) and primary arthroplasty surgical site infection (SSI) rates are declining slower than other healthcare-associated infection rates. We examined antimicrobial prophylaxis (AMP) regimens used for these operations and compared their spectrum of activity against reported SSI pathogens.Methods.Pathogen distributions of CABG and hip/knee arthroplasty complex SSIs (deep and organ/space) reported to the National Healthcare Safety Network (NHSN) from 2006 through 2009 and AMP regimens (same procedures and time period) reported to the Surgical Care Improvement Project (SCIP) were analyzed. Regimens were categorized as standard (cefazolin or cefuroxime),β-lactam allergy (vancomycin or clindamycin with or without an aminoglycoside), and extended spectrum (vancomycin and/or an aminoglycoside with cefazolin or cefuroxime). AMP activity of each regimen was predicted on the basis of pathogen susceptibility reports and published spectra of antimicrobial activity.Results.There were 6,263 CABG and arthroplasty complex SSIs reported (680,489 procedures; 880 NHSN hospitals). Among 6,574 pathogens reported, methicillin-sensitiveStaphylococcus aureus(23%), methicillin-resistantS. aureus(18%), coagulase-negative staphylococci (17%), andEnterococcusspecies (7%) were most common. AMP regimens for 2,435,703 CABG and arthroplasty procedures from 3,330 SCIP hospitals were analyzed. The proportion of pathogens predictably susceptible to standard (used in 75% of procedures),β-lactam (12%), and extended-spectrum (8%) regimens was 41%–45%, 47%–96%, and 81%—96%, respectively.Conclusion.Standard AMP, used in three-quarters of CABG and primary arthroplasty procedures, has inadequate activity against more than half of SSI pathogens reported. Alternative strategies may be needed to prevent SSIs caused by pathogens resistant to standard AMP regimens.

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Activity of Commonly Used Antimicrobial Prophylaxis Regimens against Pathogens Causing Coronary Artery Bypass Graft and Arthroplasty Surgical Site Infections in the United States, 2006–2009

Infection Control and Hospital Epidemiology ◽

10.1086/675289 ◽

2014 ◽

Vol 35 (3) ◽

pp. 231-239 ◽

Cited By ~ 31

Author(s):

Sandra I. Berríos-Torres ◽

Sarah H. Yi ◽

Dale W. Bratzler ◽

Allen Ma ◽

Yi Mu ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Antimicrobial Prophylaxis ◽

Artery Bypass ◽

Bypass Graft ◽

The United States ◽

Artery Bypass Graft ◽

Extended Spectrum ◽

Primary Arthroplasty

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EFFECT OF PREOPERATIVE RENAL DYSFUNCTION ON COST AND OUTCOMES IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT IN THE UNITED STATES BETWEEN 2004-2014

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31871-6 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1264

Author(s):

Aasim Afzal ◽

Tariq Nisar ◽

Aayla Jamil ◽

Aaron Kluger ◽

Joost Felius ◽

...

Keyword(s):

United States ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Renal Dysfunction ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

The United States ◽

Artery Bypass Graft

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Trends in Reoperative Coronary Artery Bypass Graft Surgery for Older Adults in the United States, 1998 to 2017

Journal of the American Heart Association ◽

10.1161/jaha.120.016980 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

Makoto Mori ◽

Yun Wang ◽

Karthik Murugiah ◽

Rohan Khera ◽

Aakriti Gupta ◽

...

Keyword(s):

Older Adults ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

The United States ◽

Fee For Service ◽

Artery Bypass Graft ◽

First Time

Background The likelihood of undergoing reoperative coronary artery bypass graft surgery (CABG) is important for older patients who are considering first‐time CABG. Trends in the reoperative CABG for these patients are unknown. Methods and Results We used the Medicare fee‐for‐service inpatient claims data of adults undergoing isolated first‐time CABG between 1998 and 2017. The primary outcome was time to first reoperative CABG within 5 years of discharge from the index surgery, treating death as a competing risk. We fitted a Cox regression to model the likelihood of reoperative CABG as a function of patient baseline characteristics. There were 1 666 875 unique patients undergoing first‐time isolated CABG and surviving to hospital discharge. The median (interquartile range) age of patients did not change significantly over time (from 74 [69–78] in 1998 to 73 [69–78] in 2017); the proportion of women decreased from 34.8% to 26.1%. The 5‐year rate of reoperative CABG declined from 0.77% (95% CI, 0.72%–0.82%) in 1998 to 0.23% (95% CI, 0.19%–0.28%) in 2013. The annual proportional decline in the 5‐year rate of reoperative CABG overall was 6.6% (95% CI, 6.0%–7.1%) nationwide, which did not differ across subgroups, except the non‐white non‐black race group that had an annual decline of 8.5% (95% CI, 6.2%–10.7%). Conclusions Over a recent 20‐year period, the Medicare fee‐for‐service patients experienced a significant decline in the rate of reoperative CABG. In this cohort of older adults, the rate of declining differed across demographic subgroups.

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