Association Between Surgical Site Infections and Antibiotic Prophylaxis During Arteriovenous Hemodialysis Access Creation.

Background: Antibiotic prophylaxis is recommended in vascular surgery procedures, especially when implanting prosthetic materials. However, there is a paucity of data regarding their usage or efficacy for hemodialysis (HD) access procedures, especially when an arteriovenous fistula (AVF) is planned.

Methods: A retrospective review of consecutive patients undergoing AVF for HD access between 2014 and 2019 was conducted from five safety net hospitals within the Los Angeles County Department of Health Services system. The primary endpoint was surgical site infection (SSI) at 30 days. The secondary endpoint was the usage of antibiotics and variability by surgeon and hospital.

Results: There were a total of 1,404 patients, of which 1,198 (85.3%) patients received antibiotic prophylaxis. The proportion of patients receiving antibiotics decreased from 94.8% to 82.9% over the study period (nptrend<0.02). Hospital specific rates of prophylactic antibiotic use varied significantly from 77.0% to 99.2% (p<0.001). Further, there was significant variation in rates of perioperative antibiotics utilization by surgeon, ranging from 0% to 100% (mean: 84.4%, p<0.001). There was no statistically significant difference in age (p=0.119), sex (p=0.211), and BMI (p=0.888) for patients who received antibiotics and those who did not. The overall rate of SSI at 30 days was 1.1% (n=15), with no difference for patients who received antibiotic prophylaxis and those who did not (n=12, 1.0% vs. n=3, 1.5%, p=0.55).

Conclusion: The present analysis identified hospital and surgeon level variability in the use of prophylactic antibiotics. Prophylactic antibiotics were no associated with a significant reduction in SSI rates.