1408. Effectiveness of Interventions to Decrease Gram-Positive Surgical Site Infections among Cardiac or Orthopedic Surgery Patients: A Meta-Analysis
Session: Oral Abstract Session: Predicting and Preventing SSIs
Sunday, October 23, 2011: 8:45 AM
Room: 157ABC
Background: Over 40% of surgical site infections (SSIs) are caused by Gram-positive (gram+) cocci and half are resistant to antibiotics. The usual prophylaxis for cardiac and orthopedic surgery is a beta-lactam antibiotic but glycopeptides (GLYs) may be preferred for patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) infections. Decolonization of MRSA carriers is controversial due to its expense and mupirocin resistance. Objective: To analyze the literature on interventions to decrease gram+ SSIs after cardiac, hip or knee surgery.

Methods: From an initial search of 1,038 articles, 55 were reviewed in depth and 26 met the inclusion criteria. We pooled relative risks (pRRs) from 15 studies that compared antibiotics for surgical prophylaxis and from 11 studies that assessed the effectiveness of preoperative decolonization. The outcome of interest was gram+ SSIs.

Results: The pooled effects of the prophylaxis studies showed that GLYs were not significantly protective against gram+ SSIs compared with cephalosporins (pRR=0.71; 95% confidence interval (CI): 0.37, 1.35), but a bundle including decolonization and GLYs for MRSA colonized patients was protective (pRR=0.35; 95% CI: 0.20, 0.60). Decolonization afforded a statistically significant protective effect against gram+ SSIs for cardiac (pRR=0.34; 95% CI: 0.24, 0.50) and orthopedic patients (pRR=0.40; 95% CI: 0.23, 0.69). There was a protective effect when all patients were decolonized (pRR=0.33; 95% CI: 0.23, 0.47). When only S. aureus carriers were decolonized there was a trend toward a protective effect (pRR=0.43; 95% CI: 0.18, 1.02). Decolonization with mupirocin was statistically protective against gram+ SSIs (pRR=0.38; 95% CI: 0.24, 0.66). The effect was similar when chlorhexidine gluconate was provided with mupirocin (pRR=0.39; 95% CI: 0.24, 0.64). All pooled analyses showed homogeneous effects except when GLY and cephalosporin prophylaxis was compared (heterogeneity p<0.01).

 Conclusion: Decolonization appears to be protective against gram+ SSIs after cardiac, hip or knee surgery. Decolonization plus GLYs for MRSA colonized patients was also protective. Preoperative interventions are effective at decreasing gram+ SSIs after cardiac, hip or knee surgery. 

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Marin Schweizer, PhD1, Jennifer Kroeger, MS1, Jennifer Carson, BA1, Eli Perencevich, MD, MS2, Joanne Hafner, RN, MS3, Barbara Braun, PhD3, Darryl Gray, MD, ScD4 and Loreen A. Herwaldt, MD, FIDSA1, (1)University of Iowa Carver College of Medicine, Iowa City, IA, (2)Iowa City VA Health Care System, Iowa City, IA, (3)The Joint Commission, Oakbrook Terrace, IL, (4)Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD


M. Schweizer, None

J. Kroeger, None

J. Carson, None

E. Perencevich, None

J. Hafner, None

B. Braun, None

D. Gray, None

L. A. Herwaldt, None

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