Colin H Duell, David M O'Sullivan, Anastasia Bilinskaya, Kristin E Linder
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In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. <b><i>Results:</i></b> Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. <b><i>Conclusions:</i></b> The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of Timing of Antimicrobial Surgical Prophylaxis on Rates of Surgical Site Infections.\",\"authors\":\"Colin H Duell, David M O'Sullivan, Anastasia Bilinskaya, Kristin E Linder\",\"doi\":\"10.1089/sur.2024.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Background:</i></b> Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the \\\"most optimal\\\" time for administration within the 60-min window. <b><i>Patients and Methods:</i></b> This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. <b><i>Results:</i></b> Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. <b><i>Conclusions:</i></b> The results of our analysis support current national guidelines. 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引用次数: 0
摘要
背景:手术部位感染(SSI)是常见的医疗相关感染,国家指南建议在切口前 60 分钟使用抗菌药物预防。然而,关于在 60 分钟内用药的 "最佳 "时间的数据却很有限。患者和方法:这是一项多中心回顾性研究,研究对象为接受腹部子宫切除术、结直肠手术或开颅手术并在切口60分钟内接受AP治疗的成年(≥18岁)患者。比较了在切口 0-30 分钟和 31-60 分钟内接受 AP 的患者的 SSI 发生率。此外,一项预定义的亚组分析评估了 60 分钟时间范围内 15 分钟间隔的 SSI 发生率。结果:在纳入主要分析的 277 名患者中,分别有 233 人(84.1%)和 44 人(15.9%)在切口前 0-30 分钟和 31-60 分钟接受了 AP 治疗。在主要分析中,6.0%(14/233)和 4.5%(2/44)的患者发生了 SSI(P = 0.703)。在二次分析中,分别有 137 例(49.5%)、95 例(34.3%)、34 例(12.3%)和 11 例(4.0%)患者在切口前 0-15 分钟、16-30 分钟、31-45 分钟和 46-60 分钟接受了 AP 治疗。15分钟间隔内的SSI发生率没有差异(4.4% vs. 8.4% vs. 2.9% vs. 9.1%,P = 0.487)。在本研究中发生 SSI 的 16 名患者中,有 5 名患者的培养结果呈阳性,其中 3 名患者体内的细菌被证明对 AP 使用的抗生素具有耐药性。结论:我们的分析结果支持当前的国家指导方针。根据常规处方 AP 的药代动力学,未来对不同时间间隔(如切口前 15-45 分钟 AP)的研究可能会有所帮助。
Evaluation of Timing of Antimicrobial Surgical Prophylaxis on Rates of Surgical Site Infections.
Background: Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the "most optimal" time for administration within the 60-min window. Patients and Methods: This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. Results: Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. Conclusions: The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.
期刊介绍:
Surgical Infections provides comprehensive and authoritative information on the biology, prevention, and management of post-operative infections. Original articles cover the latest advancements, new therapeutic management strategies, and translational research that is being applied to improve clinical outcomes and successfully treat post-operative infections.
Surgical Infections coverage includes:
-Peritonitis and intra-abdominal infections-
Surgical site infections-
Pneumonia and other nosocomial infections-
Cellular and humoral immunity-
Biology of the host response-
Organ dysfunction syndromes-
Antibiotic use-
Resistant and opportunistic pathogens-
Epidemiology and prevention-
The operating room environment-
Diagnostic studies