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Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection

Published online by Cambridge University Press:  21 June 2016

Judith Manniën ,
Marjo E. E. van Kasteren ,
Nico J. Nagelkerke ,
Inge C. Gyssens ,
Bart Jan Kullberg ,
Jan C. Wille  and
Annette S. de Boer
Judith Manniën*
Affiliation:
National Institute for Public Health and the Environment, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands
Marjo E. E. van Kasteren
Affiliation:
Department of Medicine, Radboud University Nijmegen Medical Centre, andNijmegen University Center for Infectious Diseases, Nijmegen, The Netherlands
Nico J. Nagelkerke
Affiliation:
National Institute for Public Health and the Environment, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands
Inge C. Gyssens
Affiliation:
Department of Medical Microbiology and Infectious Diseases and the Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
Bart Jan Kullberg
Affiliation:
Department of Medicine, Radboud University Nijmegen Medical Centre, andNijmegen University Center for Infectious Diseases, Nijmegen, The Netherlands
Jan C. Wille
Affiliation:
Dutch Institute for Healthcare Improvement CBO, Utrecht, The Netherlands
Annette S. de Boer
Affiliation:
National Institute for Public Health and the Environment, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands
*
National Institute for Public Health and the Environment, Center for Infectious Disease Epidemiology, PO Box 1, 3720 BA Bilthoven, The Netherlands (Judith.Mannien@rivm.nl)
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Abstract

Objective.

To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.

Design.

Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.

Methods.

During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).

Results.

A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P = .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).

Conclusions.

An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1340 - 1346
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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