SISNA - SIS 2010 Abstracts: ANTIBIOTIC REGIMEN AND TIMING OF PROPHYLAXIS ARE IMPORTANT FACTORS FOR LIMITING SURGICAL SITE INFECTION (SSI) IN ELECTIVE ABDOMINAL COLORECTAL SURGERY (ECRS)

SIS Foundation

ANTIBIOTIC REGIMEN AND TIMING OF PROPHYLAXIS ARE IMPORTANT FACTORS FOR LIMITING SURGICAL SITE INFECTION (SSI) IN ELECTIVE ABDOMINAL COLORECTAL SURGERY (ECRS)
Vanessa P Ho, MD, Philip S Barie, MD, MBA, Sharon L Stein, MD, Koiana Trencheva, MS, Jeffrey W Milsom, MD, Sang W Lee, MD, Toyooki Sonoda, MD, Weill Cornell Medical College

Background: Surgical site infections (SSI) cause morbidity after eCRS, and antibiotic prophylaxis can decrease SSI. This study hypothesized that antibiotic administration factors (AAF) reduce the risk of SSI.

Methods: Retrospective review from a prospective database of a random sample of patients with eCRS with anastomosis. Antibiotic regimens, initial dose timing (IDT), and redosing were evaluated. Appropriate regimens (APC) covered gram-positive cocci, gram-negative bacilli, and anaerobes. IDT was proper if given < 30 min prior to incision; redosing parameters were determined pharmacokinetically for each agent. The main outcome was SSI (CDC definitions). Sequential logistic models were generated: Model 1 assessed AAF, Model 2 controlled for patient and clinical factors^; a= 0.05*.

Results: 605 patients (292 male (48.3%), mean age 59.7 (SD 17.8) years) were included; diagnoses included cancer (235, 38.8%), IBD (133, 22.0%) and diverticulitis (107, 17.7%). 76 patients (12.6%) had incisional SSI and 54 (8.9%) had organ/space SSI. Regimens included cefazolin (CZL) + metronidazole (MET) in 219 (36.2%), cefoxitin (FOX) in 214 (35.4%), and levofloxacin (LFX) + MET in 48 (7.9%); 124 (20.5%) utilized other regimens (OTH). 55 (9.1%) received insufficient coverage, 356 (58.8%) had proper IDT, and 401 (66.3%) regimens were redosed properly. In Model 1, OTH regimens increased SSI risk, and proper IDT was protective (Table). After adding clinical factors (Model 2^), IDT remained protective; but increased OTH risk approached significance.

Conclusions: Appropriate antibiotic selection and timing of administration for prophylaxis are most crucial to limit SSI in eCRS.
Model Parameters OR 95% CI
1 CZL-MET 1.00 Reference
FOX 1.17 0.724 - 1.899
LFX-MET 0.72 0.297 - 1.723
OTH 1.963* 1.028 - 3.749
APC 1.00 Reference
Under-Coverage 0.58 0.246 - 1.365
Over-Coverage 0.74 0.261 - 2.068
IDT 0.592* 0.397 - 0.882
Redosing 0.89 0.581 - 1.363
2^ CZL-MET 1.00 Reference
FOX 1.04 0.567 - 1.903
LFX-MET 0.59 0.204 - 1.684
OTH 2.27 0.984 - 5.251
APC 1.00 Reference
Under-Coverage 0.34 0.113 - 1.041
Over-Coverage 0.37 0.099 - 1.397
IDT 0.538* 0.324 - 0.894
Redosing 0.81 0.469 - 1.412

^ disease, surgeon experience, transfusion, wound class, type of surgery, history of radiation, [albumin], comorbidities, intraoperative factors [Temp, PO2], glycemic control, ICU admission

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