Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors

James P. Steinberg; Barbara I. Braun; Walter C. Hellinger; Linda Kusek; Michele R. Bozikis; Andrew J. Bush; E. Patchen Dellinger; John P. Burke; Bryan Simmons; Stephen B. Kritchevsky; John Adams; Forest Arnold; Diane Baranowsky; Michele Barron; Beth Boersma; Antonio Cabinian; Ruth Carrico; Margaret Chambers; Cristina Cicogna; Joan Cooper; Ronald Cowan; Daniel Craig; Anthony Cutrona; Ghinwa Dumyati; Jeanne Gaber; Wanda Gillespie; Linda Greene; Heidi Hahlen; Stephen Hausrath; Walter Hellinger; Deborah Houston; Steve B. Kalish; James M. Keegan; Brian Koll; John LaJoice; Joni Lancaster; Jennifer Lee; Monica Maher; Dennis Maki; Mari Mangino; Sue Marchione; Craig A. Martin; Linda Matrician; Malkanthie I. McCormick; Emily McCraken; Kelley Melton; Leonard Mermel; Pablo Mora; Gail Morchel; Paul Newell; Joyce Nichlas; Steve Parenteau; Michael F. Parry; Ramesh Patel; Joyce Patton; Sylvia Pegg; Michael Pinell; Bruce Ribner; Gary Rifkin; Linda Riley; Edward Robinson; Nietta Rogers; Deborah Ross; Steven Salas; Robert A. Salata; Charles Salemi; Louis Schenfeld; Ann Schlimm; Matt Schuler; Martin Siegel; James Steinberg; Teresa Stowasser; John Venglarick; Robert Weinstein; Mary Wisniewski; Keith Woeltje; Carol Zuckerman

doi:10.1097/SLA.0b013e3181ad5fca

Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors

James P. Steinberg, Barbara I. Braun, Walter C. Hellinger, Linda Kusek, Michele R. Bozikis, Andrew J. Bush, E. Patchen Dellinger, John P. Burke, Bryan Simmons, Stephen B. Kritchevsky, John Adams, Forest Arnold, Diane Baranowsky, Michele Barron, Beth Boersma, Antonio Cabinian, Ruth Carrico, Margaret Chambers, Cristina Cicogna, Joan CooperRonald Cowan, Daniel Craig, Anthony Cutrona, Ghinwa Dumyati, Jeanne Gaber, Wanda Gillespie, Linda Greene, Heidi Hahlen, Stephen Hausrath, Walter Hellinger, Deborah Houston, Steve B. Kalish, James M. Keegan, Brian Koll, John LaJoice, Joni Lancaster, Jennifer Lee, Monica Maher, Dennis Maki, Mari Mangino, Sue Marchione, Craig A. Martin, Linda Matrician, Malkanthie I. McCormick, Emily McCraken, Kelley Melton, Leonard Mermel, Pablo Mora, Gail Morchel, Paul Newell, Joyce Nichlas, Steve Parenteau, Michael F. Parry, Ramesh Patel, Joyce Patton, Sylvia Pegg, Michael Pinell, Bruce Ribner, Gary Rifkin, Linda Riley, Edward Robinson, Nietta Rogers, Deborah Ross, Steven Salas, Robert A. Salata, Charles Salemi, Louis Schenfeld, Ann Schlimm, Matt Schuler, Martin Siegel, James Steinberg, Teresa Stowasser, John Venglarick, Robert Weinstein, Mary Wisniewski, Keith Woeltje, Carol Zuckerman

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Abstract

OBJECTIVE: The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). SUMMARY BACKGROUND DATA: National AMP guidelines should be supported by evidence from large contemporary data sets. METHODS: Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). RESULTS: One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but only when the preoperative dose was given correctly. CONCLUSIONS: These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.

Original language	English
Pages (from-to)	10-16
Number of pages	7
Journal	Annals of surgery
Volume	250
Issue number	1
DOIs	https://doi.org/10.1097/SLA.0b013e3181ad5fca
State	Published - Jul 2009

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Steinberg, J. P., Braun, B. I., Hellinger, W. C., Kusek, L., Bozikis, M. R., Bush, A. J., Dellinger, E. P., Burke, J. P., Simmons, B., Kritchevsky, S. B., Adams, J., Arnold, F., Baranowsky, D., Barron, M., Boersma, B., Cabinian, A., Carrico, R., Chambers, M., Cicogna, C., ... Zuckerman, C. (2009). Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors. Annals of surgery, 250(1), 10-16. https://doi.org/10.1097/SLA.0b013e3181ad5fca

@article{5ecd465ab3624b5d81fa2345c48a5f46,

title = "Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors",

abstract = "OBJECTIVE: The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). SUMMARY BACKGROUND DATA: National AMP guidelines should be supported by evidence from large contemporary data sets. METHODS: Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). RESULTS: One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but only when the preoperative dose was given correctly. CONCLUSIONS: These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.",

author = "Steinberg, {James P.} and Braun, {Barbara I.} and Hellinger, {Walter C.} and Linda Kusek and Bozikis, {Michele R.} and Bush, {Andrew J.} and Dellinger, {E. Patchen} and Burke, {John P.} and Bryan Simmons and Kritchevsky, {Stephen B.} and John Adams and Forest Arnold and Diane Baranowsky and Michele Barron and Beth Boersma and Antonio Cabinian and Ruth Carrico and Margaret Chambers and Cristina Cicogna and Joan Cooper and Ronald Cowan and Daniel Craig and Anthony Cutrona and Ghinwa Dumyati and Jeanne Gaber and Wanda Gillespie and Linda Greene and Heidi Hahlen and Stephen Hausrath and Walter Hellinger and Deborah Houston and Kalish, {Steve B.} and Keegan, {James M.} and Brian Koll and John LaJoice and Joni Lancaster and Jennifer Lee and Monica Maher and Dennis Maki and Mari Mangino and Sue Marchione and Martin, {Craig A.} and Linda Matrician and McCormick, {Malkanthie I.} and Emily McCraken and Kelley Melton and Leonard Mermel and Pablo Mora and Gail Morchel and Paul Newell and Joyce Nichlas and Steve Parenteau and Parry, {Michael F.} and Ramesh Patel and Joyce Patton and Sylvia Pegg and Michael Pinell and Bruce Ribner and Gary Rifkin and Linda Riley and Edward Robinson and Nietta Rogers and Deborah Ross and Steven Salas and Salata, {Robert A.} and Charles Salemi and Louis Schenfeld and Ann Schlimm and Matt Schuler and Martin Siegel and James Steinberg and Teresa Stowasser and John Venglarick and Robert Weinstein and Mary Wisniewski and Keith Woeltje and Carol Zuckerman",

year = "2009",

month = jul,

doi = "10.1097/SLA.0b013e3181ad5fca",

language = "English",

volume = "250",

pages = "10--16",

journal = "Annals of Surgery",

issn = "0003-4932",

number = "1",

}

Steinberg, JP, Braun, BI, Hellinger, WC, Kusek, L, Bozikis, MR, Bush, AJ, Dellinger, EP, Burke, JP, Simmons, B, Kritchevsky, SB, Adams, J, Arnold, F, Baranowsky, D, Barron, M, Boersma, B, Cabinian, A, Carrico, R, Chambers, M, Cicogna, C, Cooper, J, Cowan, R, Craig, D, Cutrona, A, Dumyati, G, Gaber, J, Gillespie, W, Greene, L, Hahlen, H, Hausrath, S, Hellinger, W, Houston, D, Kalish, SB, Keegan, JM, Koll, B, LaJoice, J, Lancaster, J, Lee, J, Maher, M, Maki, D, Mangino, M, Marchione, S, Martin, CA, Matrician, L, McCormick, MI, McCraken, E, Melton, K, Mermel, L, Mora, P, Morchel, G, Newell, P, Nichlas, J, Parenteau, S, Parry, MF, Patel, R, Patton, J, Pegg, S, Pinell, M, Ribner, B, Rifkin, G, Riley, L, Robinson, E, Rogers, N, Ross, D, Salas, S, Salata, RA, Salemi, C, Schenfeld, L, Schlimm, A, Schuler, M, Siegel, M, Steinberg, J, Stowasser, T, Venglarick, J, Weinstein, R, Wisniewski, M, Woeltje, K & Zuckerman, C 2009, 'Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors', Annals of surgery, vol. 250, no. 1, pp. 10-16. https://doi.org/10.1097/SLA.0b013e3181ad5fca

TY - JOUR

T1 - Timing of antimicrobial prophylaxis and the risk of surgical site infections

T2 - Results from the trial to reduce antimicrobial prophylaxis errors

AU - Steinberg, James P.

AU - Braun, Barbara I.

AU - Hellinger, Walter C.

AU - Kusek, Linda

AU - Bozikis, Michele R.

AU - Bush, Andrew J.

AU - Dellinger, E. Patchen

AU - Burke, John P.

AU - Simmons, Bryan

AU - Kritchevsky, Stephen B.

AU - Adams, John

AU - Arnold, Forest

AU - Baranowsky, Diane

AU - Barron, Michele

AU - Boersma, Beth

AU - Cabinian, Antonio

AU - Carrico, Ruth

AU - Chambers, Margaret

AU - Cicogna, Cristina

AU - Cooper, Joan

AU - Cowan, Ronald

AU - Craig, Daniel

AU - Cutrona, Anthony

AU - Dumyati, Ghinwa

AU - Gaber, Jeanne

AU - Gillespie, Wanda

AU - Greene, Linda

AU - Hahlen, Heidi

AU - Hausrath, Stephen

AU - Hellinger, Walter

AU - Houston, Deborah

AU - Kalish, Steve B.

AU - Keegan, James M.

AU - Koll, Brian

AU - LaJoice, John

AU - Lancaster, Joni

AU - Lee, Jennifer

AU - Maher, Monica

AU - Maki, Dennis

AU - Mangino, Mari

AU - Marchione, Sue

AU - Martin, Craig A.

AU - Matrician, Linda

AU - McCormick, Malkanthie I.

AU - McCraken, Emily

AU - Melton, Kelley

AU - Mermel, Leonard

AU - Mora, Pablo

AU - Morchel, Gail

AU - Newell, Paul

AU - Nichlas, Joyce

AU - Parenteau, Steve

AU - Parry, Michael F.

AU - Patel, Ramesh

AU - Patton, Joyce

AU - Pegg, Sylvia

AU - Pinell, Michael

AU - Ribner, Bruce

AU - Rifkin, Gary

AU - Riley, Linda

AU - Robinson, Edward

AU - Rogers, Nietta

AU - Ross, Deborah

AU - Salas, Steven

AU - Salata, Robert A.

AU - Salemi, Charles

AU - Schenfeld, Louis

AU - Schlimm, Ann

AU - Schuler, Matt

AU - Siegel, Martin

AU - Steinberg, James

AU - Stowasser, Teresa

AU - Venglarick, John

AU - Weinstein, Robert

AU - Wisniewski, Mary

AU - Woeltje, Keith

AU - Zuckerman, Carol

PY - 2009/7

Y1 - 2009/7

N2 - OBJECTIVE: The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). SUMMARY BACKGROUND DATA: National AMP guidelines should be supported by evidence from large contemporary data sets. METHODS: Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). RESULTS: One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but only when the preoperative dose was given correctly. CONCLUSIONS: These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.

AB - OBJECTIVE: The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). SUMMARY BACKGROUND DATA: National AMP guidelines should be supported by evidence from large contemporary data sets. METHODS: Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). RESULTS: One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but only when the preoperative dose was given correctly. CONCLUSIONS: These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.

UR - http://www.scopus.com/inward/record.url?scp=68249102153&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181ad5fca

DO - 10.1097/SLA.0b013e3181ad5fca

M3 - Article

C2 - 19561486

AN - SCOPUS:68249102153

SN - 0003-4932

VL - 250

SP - 10

EP - 16

JO - Annals of Surgery

JF - Annals of Surgery

IS - 1

ER -

Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors

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