The Impact of Vancomycin and Cefazolin as Standard Preoperative Antibiotic Prophylaxis on Surgical Site Infections Following Instrumented Spinal Fusion

Spine ◽  
2019 ◽  
Vol 44 (6) ◽  
pp. E366-E371 ◽  
Author(s):  
Wylie Y. Lopez ◽  
Sean M. Rider ◽  
Kenneth Nwosu ◽  
Erick R. Kazarian ◽  
Justin A. Blucher ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Spinal Fusion ◽  
Surgical Site Infections ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Impact

scholarly journals A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 768
Author(s):  
Yoann Varenne ◽  
Stéphane Corvec ◽  
Anne-Gaëlle Leroy ◽  
David Boutoille ◽  
Mỹ-Vân Nguyễn ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Surgical Site Infections ◽  
Implant Removal ◽  
Pelvic Bone ◽  
Resistance Pattern ◽  
Cure Rate ◽  
Implant Retention ◽  
The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

The impact of surgical site infections on hospital contribution margin—a European prospective observational cohort study

2019 ◽  
Vol 40 (12) ◽  
pp. 1374-1379
Author(s):  
Marco von Strauss ◽  
Walter R. Marti ◽  
Edin Mujagic ◽  
Michael Coslovsky ◽  
Katharina Diernberger ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Diagnosis Related Groups ◽  
Controlled Trial ◽  
Private Insurance ◽  
Surgical Site Infections ◽  
Positive Contribution ◽  
Contribution Margin ◽  
Multicenter Randomized Controlled Trial ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Impact

AbstractBackground:Surgical site infections (SSIs) are common surgical complications that lead to increased costs. Depending on payer type, however, they do not necessarily translate into deficits for every hospital.Objective:We investigated how surgical site infections (SSIs) influence the contribution margin in 2 reimbursement systems based on diagnosis-related groups (DRGs).Methods:This preplanned observational health cost analysis was nested within a Swiss multicenter randomized controlled trial on the timing of preoperative antibiotic prophylaxis in general surgery between February 2013 and August 2015. A simulation of cost and income in the National Health Service (NHS) England reimbursement system was conducted.Results:Of 5,175 patients initially enrolled, 4,556 had complete cost and income data as well as SSI status available for analysis. SSI occurred in 228 of 4,556 of patients (5%). Patients with SSIs were older, more often male, had higher BMIs, compulsory insurance, longer operations, and more frequent ICU admissions. SSIs led to higher hospital cost and income. The median contribution margin was negative in cases of SSI. In SSI cases, median contribution margin was Swiss francs (CHF) −2045 (IQR, −12,800 to 4,848) versus CHF 895 (IQR, −2,190 to 4,158) in non-SSI cases. Higher ASA class and private insurance were associated with higher contribution margins in SSI cases, and ICU admission led to greater deficits. Private insurance had a strong increasing effect on contribution margin at the 10th, 50th (median), and 90th percentiles of its distribution, leading to overall positive contribution margins for SSIs in Switzerland. The NHS England simulation with 3,893 patients revealed similar but less pronounced effects of SSI on contribution margin.Conclusions:Depending on payer type, reimbursement systems with DRGs offer only minor financial incentives to the prevention of SSI.

scholarly journals 43. Impact of a Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Antibiotic Prophylaxis Selection in Surgery in a Hospital without Restrictions on Antibiotics Prescription in Costa Rica

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
José P Díaz-Madriz ◽  
Esteban Zavaleta-Monestel ◽  
Jorge A Villalobos-Madriz ◽  
Alison V Meléndez-Alfaro ◽  
Priscilla Castrillo-Portillo ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Antimicrobial Stewardship ◽  
Bacterial Resistance ◽  
Positive Impact ◽  
Surgical Site Infections ◽  
Antimicrobial Stewardship Program ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Impact ◽  
Selection Of

Abstract Background In a private hospital without restrictions on antibiotic prescription, the success of an Antimicrobial Stewardship Program (ASP) depends mainly on prospective feedback and education. Previously, the ASP of this hospital (PROA-HCB) managed to achieve a positive impact on the antibiotic prophylaxis in cesarean delivery. The purpose of this study is to characterize the impact after implementing the PROA-HCB on the optimal prophylaxis selection of all the procedures included in the clinical guideline for surgical antibiotic prophylaxis in adult patients. Methods A retrospective observational study that compares the selection, duration, antibiotic consumption, bacterial resistance profiles and patient’s safety outcomes regarding antibiotic use for all surgical prophylaxis prescription over six months for the periods before (pre-ASP) and after a five-year intervention of PROA-HCB (post-ASP). Results After a five-year intervention, the percentage of optimal selection of antibiotic prophylaxis in Surgery was 21.0% (N=1598) in the pre-ASP period and 80.0% (N=841) in the post-ASP period (59% absolute improvement, p < 0.001). Percentage of optimal duration was 69,1% (N=1598) in the pre-ASP period and 78.0% (N=841) in the post-ASP period (8.9% absolute improvement, p < 0.001). Mean ceftriaxone utilization was 217.7 defined daily doses (DDD) per 1,000 patient days DDD for the pre-ASP period and 139.8 DDD per 1,000 patient days for the ASP period (35.8% decrease; p = 0.019). Mean cefazolin utilization was 14.9 DDD per 1,000 patient days for the pre-ASP period and 153.3 DDD per 1,000 patient days for the ASP period (928.6% increase; p = 0.021). Regarding percentage of bacterial resistance, there was detected an improvement in some isolates like Escherichia coli with a decrease of ESBL detection (11% decrease; p = 0.007). In addition, no serious adverse reactions or an increase in surgical site infections were detected after the intervention. Conclusion The implementation of an ASP in the surgical ward showed an overall positive impact on selection and duration of antibiotic prophylaxis. Furthermore, this intervention could have had a positive impact on antimicrobial resistance and at the same time had no negative effects on the patients. Disclosures All Authors: No reported disclosures

scholarly journals 137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S182-S182
Author(s):  
Xue Fen Valerie Seah ◽  
Yue Ling Rina Ong ◽  
Wei Ming Cedric Poh ◽  
Shahul Hameed Mohamed Siraj ◽  
Kai-Qian Kam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Patient Outcomes ◽  
Phase 1 ◽  
Surgical Site Infections ◽  
Phase 2 ◽  
Oral Antibiotics ◽  
Post Intervention ◽  
Phase 3 ◽  
The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

Effect of Preoperative Antibiotic Prophylaxis on Surgical Site Infections Complicating Cardiac Surgery

2014 ◽  
Vol 35 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Renato Finkelstein ◽  
Galit Rabino ◽  
Tania Mashiach ◽  
Yaron Bar-El ◽  
Zvi Adler ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Control Program ◽  
Risk Category ◽  
Infection Control Program ◽  
Preoperative Antibiotic Prophylaxis ◽  
Preoperative Hospital Stay ◽  
Preoperative Prophylaxis

Objective.To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery.Design.Prospective cohort study.Setting.Tertiary medical center in Israel.Methods.SSIs were recorded during a 10-year study period and ascertained through routine surveillance using the National Healthcare Safety Network (NHSN) methodology. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes.Results.A total of 2,637 of 3,170 evaluated patients were included, and the overall SSI rate was 8.4%. A greater than 50% reduction in SSI rates was observed in the last 4 years of the study. Overall and site-specific infection rates were similar for patients receiving cefazolin or vancomycin. SSIs developed in 206 (8.1%) of the 2,536 patients who received preoperative prophylaxis (within 2 hours of the first incision) compared with 14 (13.9%) of 101 patients who received antibiotic prophylaxis at a different time (P= .04; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0–3.3). After accounting for covariates, preoperative hospital stay (5 days or more), an NHSN risk category (2 or 3), age (60 years or more), surgeon's role, and the period of measurement were significantly associated with SSIs. Emergency surgery, age, surgeon's role, and nonpreoperative prophylaxis were found to be independent predictors of superficial SSI.Conclusions.We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative prophylaxis in cardiac surgery.

Surgical-Site Infection Following Spinal Fusion: A Case-Control Study in a Children's Hospital

2003 ◽  
Vol 24 (8) ◽  
pp. 591-595 ◽  
Author(s):  
Annie-Claude Labbé ◽  
Anne-Marie Demers ◽  
Ramona Rodrigues ◽  
Vincent Arlet ◽  
Kim Tanguay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Spinal Fusion ◽  
Spinal Surgery ◽  
Case Control Study ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Case Control ◽  
Gram Negative Organisms ◽  
Control Study

AbstractObjectives:To determine the rates of surgical-site infections (SSIs) after spinal surgery and to identify the risk factors associated with infection.Design:SSIs had been identified by active prospective surveillance. A case-control study to identify risk factors was performed retrospectively.Setting:University-associated, tertiary-care pediatric hospital.Patients:All patients who underwent spinal surgery between 1994 and 1998. Cases were all patients who developed an SSI after spinal surgery. Controls were patients who did not develop an SSI, matched with the cases for the presence or absence of myelodysplasia and for the surgery date closest to that of the case.Results:There were 10 infections following 125 posterior spinal fusions, 4 infections after 50 combined anterior-posterior fusions, and none after 95 other operations. The infection rate was higher in patients with myelodysplasia (32 per 100 operations) than in other patients (3.4 per 100 operations; relative risk = 9.45; P < .001). Gram-negative organisms were more common in early infections and Staphylococcus aureus in later infections. Most infections occurred in fusion involving sacral vertebrae (odds ratio [OR] = 12.0; P = .019). Antibiotic prophylaxis was more frequently suboptimal in cases than in controls (OR = 5.5; P = .034). Five patients required removal of instrumentation and 4 others required surgical debridement.Conclusions:Patients with myelodysplasia are at a higher risk for SSIs after spinal fusion. Optimal antibiotic prophylaxis may reduce the risk of infection, especially in high-risk patients such as those with myelodysplasia or those undergoing fusion involving the sacral area.

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