517. Factors Associated with Adherence to Antibiotic Surgical Prophylaxis Guidelines at a Large Academic Medical Center
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Surgical Prophylaxis IDSA Poster_FINAL_Cirrone_2013.pdf (272.0 kB)
  • Background:

    Periprocedural antibiotics for prophylaxis of surgical site infections (SSI) are recommended for many procedures.  National guidelines have outlined metrics to assess appropriate prophylaxis.  The purpose of this study was to evaluate factors associated with nonadherence that could be targeted for interventions.


    Data were extracted on all adult operating room procedures from January-June 2012 at our institution from an electronic database.  Each procedure was assessed for antibiotic selection, timing prior to incision, and intra-procedural redosing, in accordance with national and institutional guidelines for each procedure type and antibiotic.  Procedure types, antibiotic classes, and patient factors (weight, allergies) were assessed in relation to adherence to recommendations for selection, timing, and dosing of antibiotic prophylaxis.


    A total of 9,703 procedures were evaluated with the most common being orthopedic (19%), gynecologic (10%), cardiothoracic (10%), vascular (9%), and neurosurgical (9%).  Overall adherence to selection was 94%. Use of cefazolin or cefoxitin in 6,678 procedures was optimal >99% of the time, while piperacillin/tazobactam 224/9703 (2%) and levofloxacin 66/9703 (0.7%) were the most common agents associated with suboptimal selection.  Any listed beta-lactam allergy decreased optimal selection [88% vs. 94%, p<0.001].  Weight-based dosing of vancomycin (≥ 12 mg/kg/dose) was appropriate in 210/341 (62%).  Overall adherence to initial antibiotic timing pre-incision was 97%. Administration 0-14 minutes prior to incision was common [3634/8322 (44%)], including 974/8322 (12%) administered 0-5 minutes prior. Intraoperative redosing was infrequently needed [1465/9703 (15%)] but optimal (+/- 1 hour) in 84%. 


    Although limited by evaluation of electronic documentation only, overall adherence was high in this single center study. Issues not commonly targeted by quality improvement initiatives, namely use of select broad-spectrum antibiotics, antibiotic selection in the setting of allergy, optimal dosing in overweight patients, and intraoperative redosing may warrant further attention.  The impact of antibiotic timing immediately (0-5 minutes) before incision warrants additional correlation with SSI data.

    Frank Cirrone, PharmD1, Christine J. Kubin, PharmD1,2 and E. Yoko Furuya, MD, MS1,2, (1)NewYork-Presbyterian Hosp, New York, NY, (2)Columbia University, New York, NY


    F. Cirrone, None

    C. J. Kubin, None

    E. Y. Furuya, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.