Association Between Antimicrobial Prophylaxis With Double-Dose Cefuroxime and Surgical Site Infections in Patients Weighing 80 kg or More

Abstract

IMPORTANCE Many guidelines recommend a weight-adopted dose increase of cefuroxime for surgical antimicrobial prophylaxis (SAP). However, the evidence that this approach is associated with lower rates of surgical site infection (SSI) is limited.OBJECTIVE To assess whether double-dose cefuroxime SAP was associated with a decreased SSI rate in patients weighing at least 80 kg. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients (>18 years)weighing at least 80 kg who underwent 9 major surgical procedures with a cefuroxime SAP administration from the Swissnoso SSI surveillance system between January 2015 and December 2019 at 142 Swiss hospitals. The follow-up was 30 days for all surgical procedures and 1 year for implant-related operations.EXPOSURES Cefuroxime SAP dose (1.5 vs 3.0 g). MAIN OUTCOMES AND MEASURESOverall SSI. A mixed-effects logistic regression adjusted for institutional, epidemiological, and perioperative variables was applied. Results were stratified by weight categories as well as by wound contamination classes. RESULTSOf 41 076 eligible patients, 37 640 were included, with 22 625 (60.1%) men and a median (IQR) age of 61.9 (49.9-71.1) years. The outcome SSI was met by 1203 patients (3.2%). Double-dose cefuroxime was administered to 13 246 patients (35.2%) and was not significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.89; 95% CI, 0.78-1.02; P = .10). After stratification by weight category, double-dose SAP vs single-dose SAP was associated with lower SSI rates among 16 605 patients weighing at least 80 to less than 90 kg (aOR, 0.76; 95% CI, 0.61-0.97; P = .02) but not in the other weight categories (Ն90 to <100 kg, 10 342 patients: aOR, 1.12; 95% CI, 0.87-1.47;

Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

“…Although our primary exposure variable was the exact timing of SAP administration, our data confirm findings from many previous studies that other confounders are significantly associated with SSI risk: higher ASA score, clean-contaminated wound classes (vs clean), and surgical procedures exceeding standard time were associated with an increased risk, as shown elsewhere. The duration of the surgical procedure can be impacted by intraoperative complications that may further affect the healing process and increase the risk for SSI.…”

“…The RCT may have been confounded, as a higher dose of SAP for patients with a body weight above 80 kg was introduced during the study period, which could have interacted with the timing windows. Nonetheless, a recent study by our group demonstrated that doubling the dose of cefuroxime in most surgical procedures does not decrease SSI rates. In addition, the RCT was stratified by center and may have been confounded by differences between the 2 participating centers (eg, different case mix as well as experience and skills of surgical staff).…”

“…Nonetheless, a recent study 20 by our group demonstrated that doubling the dose of cefuroxime in most surgical procedures does not decrease SSI rates. In addition, the RCT 14 and may have been confounded by differences between the 2 participating centers (eg, different case mix as well as experience and skills of surgical staff).…”

“…Surveillance staff reviewed all patient data, and patients with a suspected SSI were validated by a dedicated physician. Staff members of the Swissnoso SSI surveillance team periodically performed on-site audits to check data quality, which are published elsewhere …”

“…Staff members of the Swissnoso SSI surveillance team periodically performed on-site audits to check data quality, which are published elsewhere. [16][17][18]20,21…”