Your browser doesn't support javascript.
Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019-2020.
Cabral, Stephanie M; Harris, Anthony D; Cosgrove, Sara E; Magder, Laurence S; Tamma, Pranita D; Goodman, Katherine E.
  • Cabral SM; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Harris AD; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Cosgrove SE; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Magder LS; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Tamma PD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Goodman KE; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis ; 76(12): 2106-2115, 2023 Jun 16.
Article in English | MEDLINE | ID: covidwho-2239460
ABSTRACT

BACKGROUND:

There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives.

METHODS:

We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence.

RESULTS:

Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR .92; 95% CI .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR 1.19; 95% CI 1.11-1.27; P < .001).

CONCLUSIONS:

Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Methicillin-Resistant Staphylococcus aureus / Acute Kidney Injury / COVID-19 / Anti-Infective Agents Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2023 Document Type: Article Affiliation country: Cid

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Methicillin-Resistant Staphylococcus aureus / Acute Kidney Injury / COVID-19 / Anti-Infective Agents Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2023 Document Type: Article Affiliation country: Cid