2193. Optimal Timing of Surgical Antimicrobial Prophylaxis with Cefuroxim: Challenging the WHO Guidelines with 121'000 prospectively followed Patients
Session: Poster Abstract Session: HAI: Surgical Site Infections
Saturday, October 7, 2017
Room: Poster Hall CD

Background: Surgical antimicrobial prophylaxis (SAP) is standard of care in clean surgery involving implants and in clean-contaminated surgical procedures. Timing of application of the antibiotic remains a debate: WHO recently extended the time prior to incision from 60 minutes to 120 minutes, while CDC considers the available  data insufficient to provide evidence-based guideline for timing. In addition, studies to date included different types of antibiotics with different T ½. Therefore, we prospectively followed 250‘000 patients to further define the optimal timing for SAP

Methods: The Swiss national center for infection prevention (www.swissnoso.ch) started surveillance for surgical site infection (SSI) in 2009. Currently, 172 institutions participate throughout Switzerland, with routine postdicharge surveillance (adherence >90%) and on-site quality audits by a physician or infection control practitioner. The data collection includes age, sex, type of surgery, timing of SAP in minutes prior to incision, BMI, ASA score, antimicrobial agent. Inclusion criteria for this study were: adult patients undergoing cardiac surgery, orthopedic or abdominal surgery, antimicrobial prophylaxis with cefuroxime only (+metronidazole for abdominal surgery) and pathogen identified in cases of SSI was cefuroxime-susceptible. Data were analyzed using a generalized additive model (GAM) to allow non-parametric fits with relaxed assumptions on the actual relationship between response and predictor

Results: Of the 258‘481 patients in the national SSI surveillance database 121‘645 fulfilled the inclusion criteria (38% of patients did not require SAP, 18% had surgery with contaminated or dirty wounds, 2.7% were <18 years and data on timing and class of antibiotic were missing in 5.7%). The lowest risk of SSI was observed with application of SAP 0-30min prior incision, even after adjustment for age, sex, ASA score, type of surgery , BMI, and T1/2. (Figure, CI95 in blue area)


Conclusion: Timing of SAP (with cefuroxime) 0-30 minutes prior to incision was associated with the lowest risk of SSI , challenging a previous randomized controlled trial  and recent WHO guidelines.

Andreas F. Widmer, MD, MS, Infectious Diseases, University of Basel Hospitals and Clinics, Basel, Switzerland, Nicolas Troillet, MD, MSc, Infectious Disease Hospital Epidemiology, Valais hospital, Sion, Switzerland, Maurus Thurneysen, MSc ETH, Division of Infectious Disease & Hospital Epidemiology, University of Basel, Basel, Switzerland, Andrew Atkinson, Msc, Infectious Disease Hospital Epidemiology, University of Bern, Bern, Switzerland, Marc Dangel, MPH, University Hospital Basel, basel, Switzerland, Stefan P Kuster, MD MSc, Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland, Jonas Marschall, MD, Infectious Diseases and Hospital Epidemiology, University Hospital Bern, Bern, Switzerland and Swissnoso study group


A. F. Widmer, None

N. Troillet, None

M. Thurneysen, None

A. Atkinson, None

M. Dangel, None

S. P. Kuster, None

J. Marschall, None

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