1467. Cefazolin-based antimicrobial prophylaxis may reduce surgical site infections in patients undergoing peripheral vascular bypass surgery
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Background: Surgical site infection (SSI) is one of the most common nosocomial infections despite advances in infection control practices. The rate of SSI following peripheral vascular bypass surgery (PVBY) is high compared to other surgeries performed at Maine Medical Center. The purpose of our study was to identify perioperative factors associated with SSI in patients undergoing lower extremity PVBY.

Methods: A single-center case-control study was performed. The National Healthcare Safety Network (NHSN) was used to identify patients ≥ 18 years old who underwent lower extremity PVBY between January 2013 and May 2015. Patients with SSI were pre-identified using standardized 90-day surveillance definitions from the NHSN. Patient comorbidities, antimicrobial allergies, perioperative antimicrobial use and operative characteristics were collected. Perioperative variables associated with SSI were evaluated using multivariable logistic regression.

Results: One-hundred forty-one patients were included, 41 with SSI and 100 controls. There were no significant differences in age, gender, obesity, diabetes, smoking history or American Society of Anesthesiologists physical status scale between the two groups. Percentage of patients reporting beta-lactam allergy was 24.4% and 11% in the SSI and control groups, respectively (P = .042). Median procedure duration was 270 and 199 minutes in the SSI and control groups, respectively (P = .001). Fewer patients in the SSI group received cefazolin-based antimicrobial prophylaxis compared to the control group (68.3 % vs. 87%, respectively, P = .009). Multivariable analysis showed that procedure duration greater than 220 minutes was an independent predictor of SSI (OR, 4.11; 95% CI, 1.84-9.20; P = .001). Antimicrobial prophylaxis with a cefazolin-based regimen was protective against SSI (OR, 0.29; 95% CI, 0.11-0.73; P = .009).

Conclusion: Surgical site infections were less common in patients receiving cefazolin-based antimicrobial prophylaxis prior to undergoing lower extremity PVBY. Allergies may contribute to the number of patients who did not receive a cefazolin-based regimen. Further studies are required to define optimal antimicrobial prophylaxis in the setting of beta-lactam allergies.

Alexis Thayer, PharmD1, Kathryn Smith, PharmD, BCPS1, David Clark, MD2, Robert Hawkins, MD3, Patricia Stogsdill, MD4 and Kristina Rokas, PharmD, BCPS1, (1)Pharmacy, Maine Medical Center, Portland, ME, (2)Surgery, Maine Medical Center, Portland, ME, (3)Vascular Surgery, Maine Medical Center, Portland, ME, (4)Infectious Diseases, Maine Medical Center, Portland, ME

Disclosures:

A. Thayer, None

K. Smith, None

D. Clark, None

R. Hawkins, None

P. Stogsdill, None

K. Rokas, None

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