1466. Asymptomatic Bacteriuria and The Impact of Treatment on Surgical Site Infections in Coronary Artery Bypass Grafting Surgery Patients
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • 56579_IDWPOSTER.pdf (251.5 kB)
  • Background: Evidence for asymptomatic bacteriuria (ABS) treatment in the preoperative management of cardiac surgery is limited, resulting in uncertainty and variations within practice. Unnecessary treatment of ASB may lead to the development of antibiotic resistance, loss of endogenous microflora, potential side effects, and increased costs. However, potential perioperative hematogenous spread of genitourinary bacteria may increase the patient’s risk for postoperative infections including surgical site infections (SSI). The primary purpose of this study is to evaluate whether treatment of ASB has an impact on the occurrence of SSIs specifically in non-valvular coronary artery bypass grafting (CABG) patients.

    Methods: A retrospective, single-center, non-inferiority study was conducted in adult patients with ASB prior to CABG surgery between 1/1/10 and 8/31/15. Clinical characteristics, microbiology and urinalysis results, treatment, documented UTI symptoms, and SSIs were collected.

    Results: A total of 3759 patients undergoing CABG without valve replacement were screened for ICD-9 codes indicating ASB or possible UTI; 319 were identified and 81 met inclusion criteria for ASB. SSIs occurred in 11 of 81 asymptomatic CABG patients with positive urine cultures: 10 patients (9 sternal wound SSI and 1 harvest wound SSI) received treatment for ASB and 1 patient with sternal wound SSI did not receive treatment for ASB. Among patients who received treatment for ASB and those who did not, there were no major differences in baseline characteristics, length of stay (12.3 vs. 11.9 days; p = 0.798) or SSI (14.3% treated ASB vs. 9.1% untreated ASB; p = 0.204). None of the microorganisms isolated in the urine culture prior to surgery corresponded to those found in the wound cultures from SSI.

    Conclusion: While there was a trend favoring non-treatment of ASB, data is insufficient to definitively prove that not receiving treatment is not worse in term of SSI outcomes to receiving treatment for ASB prior to CAGB surgery. Taken together with data from other surgical specialties indicating preoperative treatment of ASB is not indicated, we recommend against routine preoperative urine testing prior to non-valvular CABG surgery in order to avoid unnecessary treatment of ASB.

    Vata Hernandez, PharmD1, Mary Beth Brinkman, PharmD, PhD, BCPS1, Sarah Fraker, MS, CHDA2, Elizabeth Mcneely, PharmD, BCPS – AQ Cardiology3 and Seenu Reddy, MD, MBA4, (1)TriStar Centennial Medical Center, Nashville, TN, (2)Data and Analytics, Clinical Services Group, Hospital Corporation of America Healthcare, Nashville, TN, (3)Finance & Administration, Clinical Services Group, Hospital Corporation of America Healthcare, Nashville, TN, (4)Cardiovascular Surgery, TriStar Medical Group Cardiovascular Surgery, Nashville, TN

    Disclosures:

    V. Hernandez, None

    M. B. Brinkman, None

    S. Fraker, None

    E. Mcneely, None

    S. Reddy, None

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