359. National Trends in Vancomycin use for peri-operative prophylaxis over 5 years
Session: Poster Abstract Session: HAI: Surgical Site Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • National Trends in Perioperative Vancomycin Usefinalpdf.pdf (1.2 MB)
  • Background: With rising rates of MRSA, consideration of MRSA-active antibiotics such as  vancomycin (V) for surgical prophylaxis is increasing. Although guidelines support the use of V in MRSA-colonized patients, the real-world implementation of these recommendations remains unknown.

    Methods: All patients who underwent surgery within the national VA health care system, and had surgical prophylaxis data validated during the period from 10/1/08-9/30/13 were included. Primary outcome was the longitudinal incidence of V use; secondary analyses included stratification by type of surgical procedure and MRSA-colonization status.

    Results: 79458 unique procedures were included.  27458 patients had a nasal screen or a positive culture for MRSA pre-operatively; 1335 (5%) were positive. V was used in 25.4% of cases (20056/79458). Among MRSA positive patients, 49% received V. Among MRSA-negative and unknown cases, 24% and 27% received V, respectively. During the study period, the use of V monotherapy decreased from 9.5% to 7.9%, whereas V plus a Beta-lactam antibiotic (BLA) increased from 14% in 2009 to 18% in 2013. The use of BLA monotherapy did not change. In the sub-analysis, V plus BLA use increased the most considerably for cardiac procedures, from 28% to 37%; V alone decreased from 18% to 13%. A similar trend in V plus BLA use was seen in orthopedic procedures (12% to 16%).   

    Conclusion: In this national longitudinal cohort, approximately 50% of known MRSA-colonized patients receive an MRSA-active antibiotic for peri-operative prevention of surgical site infections (SSI). The use of V-BLA combination is increasing for certain surgical procedures. Further investigation is needed into ways to improve implementation of evidence-based guidelines for SSI prevention.

    Judith Strymish, MD, Harvard Medical School, Boston, MA; Infectious Disease, VA Boston Healthcare System, West Roxbury, MA, Westyn Branch-Elliman, MD, MMSc, Medicine, University of Colorado, Aurora, CO; Division of Infectious Diseases, Denver VA Medical Center, Denver, CO, Kamal Itani, MD, Department of Surgery, VA Boston and Boston University School of Medicine, West Roxbury, MA and Kalpana Gupta, MD, MPH, Department of Medicine/Boston University School of Medicine, Boston, MA; VA Boston Health Care System, West Roxbury, MA

    Disclosures:

    J. Strymish, None

    W. Branch-Elliman, None

    K. Itani, Sanofi: Investigator , Grant recipient

    K. Gupta, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.