Prophylactic Antibiotic Choice Impacts Postsurgical Infections

Prophylactic antibiotic choice impacts the risk of surgical site infection (SSI) rates in women undergoing hysterectomy, according to a new study.

Researchers at the University of Michigan (Ann Arbor, USA), the University of Wisconsin (WISC; Madison, USA), and other institutions conducted a retrospective cohort study of 21,358 hysterectomies performed from July 2012 to February 2015. Patients receiving a recommended preoperative antibiotic regimen were categorized into those receiving β-lactams and those receiving an alternative antibiotic. Patients receiving non-recommended antibiotics were categorized into those receiving overtreatment and those receiving nonstandard antibiotics. The primary outcome was a composite outcome of any SSI.

The results showed that the overall rate of any SSI was 2.06%. The unadjusted rates of SSI were 1.8%, 3.1%, and 3.7% for β-lactam, β-lactam alternatives, and nonstandard groups, respectively. After adjusting for patient and operative factors within clusters of hospitals, as compared with the β-lactam antibiotics, the risk of any SSI was higher for the group receiving approved β-lactam alternatives or the nonstandard antibiotics. The study was published in the February 2016 issue of Obstetrics & Gynecology.

“Compared with women receiving β-lactam antibiotic regimens, there is a higher risk of surgical site infection after hysterectomy among those receiving a recommended alternative or nonstandard regimen,” concluded lead author Shitanshu Uppal, MBBS, and colleagues. “Efforts to decrease surgical site infections could focus on adherence to recommended preoperative antibiotic guidelines and thorough evaluation of patient-reported penicillin allergies to increase the number of patients receiving β-lactam antibiotics.”

SSIs may be the most frequent healthcare-associated infection (HAI) after asymptomatic bacteriuria, representing a high burden on patients and hospitals in terms of morbidity, mortality, prolonged length of hospital stay, and additional costs. Each year, approximately 500,000 surgical patients develop SSIs.

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