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Perioperative antimicrobial prophylaxis and prevention of hepatobiliary surgical site infections

Published online by Cambridge University Press:  01 August 2018

Conor M. Stack Open the ORCID record for Conor M. Stack [Opens in a new window] ,
Howard S. Gold ,
Sharon B. Wright ,
Linda M. Baldini  and
Graham M. Snyder
Conor M. Stack*
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Howard S. Gold
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Sharon B. Wright
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Linda M. Baldini
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Graham M. Snyder
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Author for correspondence: Conor Stack, MD, Mailstop SL-435, 330 Brookline Ave, Boston, MA 02115. E-mail: cstack1@bidmc.harvard.edu
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Abstract

Objective

To characterize the microbiology of hepatobiliary surgical site infections (SSIs) and to explore the relationship between specific antimicrobial prophylaxis regimens and the development of SSIs.

Design

Retrospective matched case-control study comparing patient, procedure, and antimicrobial prophylaxis characteristics among patients undergoing a hepatobiliary surgical procedure with and without an SSI.

Setting

A tertiary referral acute-care facility.

Methods

Patients undergoing procedures defined as “BILI” (bile duct, liver, or pancreas surgery) using National Healthcare Safety Network (NHSN) definitions, excluding those undergoing concomitant liver transplantation, from January 2013 through June 2016 were included in the study population. The SSIs were identified through routine infection control surveillance using NHSN definitions. All patients who developed an SSI were considered cases. Controls were selected randomly matched 2:1 with cases based on fiscal quarter of the procedure. Logistic regression modeling was performed to explore variables associated with SSI, including antimicrobial prophylaxis received.

Results

Among 975 procedures, 80 (8.2%) resulted in an SSI. Most cases involved an organism nonsusceptible to standard prophylaxis regimens, including cefazolin (68.8%), cefazolin plus metronidazole (61.3%), and ampicillin-sulbactam (52.5%). In a multivariate model, antimicrobial coverage against Enterococcus spp (aOR, 0.58; 95% confidence interval [CI], 0.17–2.04; P=.40) and against Pseudomonas spp (aOR, 2.40; 95% CI, 0.56–10.29; P=.24) were not protective against the development of an SSI. The presence of a documented β-lactam allergy was significantly associated with the development of an SSI (aOR, 3.54; 95% CI, 1.36–9.19; P=.009).

Conclusions

Although SSIs at the study institution were associated with pathogens nonsusceptible to the most commonly used prophylaxis regimens, broader-spectrum coverage was not associated with a reduction in SSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1037 - 1041
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Stack C, et al. (2018). Perioperative antimicrobial prophylaxis and prevention of hepatobiliary surgical site infections. Infection Control & Hospital Epidemiology 2018, 39, 1037–1041. doi: 10.1017/ice.2018.164

PREVIOUS PRESENTATION: Findings from this study were presented at The Society for Healthcare Epidemiology of America Spring 2017 Conference in St. Louis, Missouri, on March 30, 2017 (poster no. 304).

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