Timing of Antibiotic Prophylaxis of Surgical-Site Infection
These findings are intriguing and should be assessed in the context of the limitations of the study. The study population was largely male, redosing and microbiologic characteristics of SSI were not studied, and the proportion of cases in which the antibiotic failed to be administered within the SCIP-approved window was relatively small. The findings suggest that giving the antibiotic in the exact 60-minute window before incision may not be as critical a factor in reducing SSI as previously thought. In this respect, resources spent to ensure compliance with this requirement may be better spent in making sure that an appropriate antibiotic is given within a reasonable time window before the incision.
A more interesting finding from this observational study pertains to the choice of antibiotic agent. What is given may be more important than when it is given. Vancomycin alone for orthopedic procedures appeared to increase the risk for SSI; this finding is not surprising, given the relatively poor activity of vancomycin against Staphylococcus aureus compared with a beta-lactam, such as cefazolin. The results of the study suggest that when vancomycin is selected for surgical prophylaxis (usually for patients with allergy to beta-lactams or a history of methicillin-resistant S aureus), a second agent should be considered, given in combination with vancomycin. These findings have implications not only for patient outcomes but also for antibiotic stewardship.
In conclusion, the timing of surgical prophylaxis administration is not independently associated with the risk for SSI in patients undergoing orthopedic, vascular, colorectal, or gynecologic procedures. Vancomycin alone is associated with a higher risk for SSI in patients undergoing orthopedic procedures.
Abstract
Viewpoint
These findings are intriguing and should be assessed in the context of the limitations of the study. The study population was largely male, redosing and microbiologic characteristics of SSI were not studied, and the proportion of cases in which the antibiotic failed to be administered within the SCIP-approved window was relatively small. The findings suggest that giving the antibiotic in the exact 60-minute window before incision may not be as critical a factor in reducing SSI as previously thought. In this respect, resources spent to ensure compliance with this requirement may be better spent in making sure that an appropriate antibiotic is given within a reasonable time window before the incision.
A more interesting finding from this observational study pertains to the choice of antibiotic agent. What is given may be more important than when it is given. Vancomycin alone for orthopedic procedures appeared to increase the risk for SSI; this finding is not surprising, given the relatively poor activity of vancomycin against Staphylococcus aureus compared with a beta-lactam, such as cefazolin. The results of the study suggest that when vancomycin is selected for surgical prophylaxis (usually for patients with allergy to beta-lactams or a history of methicillin-resistant S aureus), a second agent should be considered, given in combination with vancomycin. These findings have implications not only for patient outcomes but also for antibiotic stewardship.
In conclusion, the timing of surgical prophylaxis administration is not independently associated with the risk for SSI in patients undergoing orthopedic, vascular, colorectal, or gynecologic procedures. Vancomycin alone is associated with a higher risk for SSI in patients undergoing orthopedic procedures.
Abstract