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.
K. Itani, Sanofi: Investigator , Grant recipient
K. Gupta, None