Impact of bodyweight-adjusted antimicrobial prophylaxis on surgical-site infection rates

Abstract

Background Antimicrobial prophylaxis (AMP) adjustment according to bodyweight to prevent surgical-site infections (SSI) is controversial. The impact of weight-adjusted AMP dosing on SSI rates was investigated here. Methods Results from a first study of patients undergoing visceral, vascular or trauma operations, and receiving standard AMP, enabled retrospective evaluation of the impact of bodyweight and BMI on SSI rates, and identification of patients eligible for weight-adjusted AMP. In a subsequent observational prospective study, patients weighing at least 80 kg were assigned to receive double-dose AMP. Risk factors for SSI, including ASA classification, duration and type of surgery, wound class, diabetes, weight in kilograms, BMI, age, and AMP dose, were evaluated in multivariable analysis. Results In the first study (3508 patients), bodyweight and BMI significantly correlated with higher rates of all SSI subclasses (both P < 0.001). An 80-kg cut-off identified patients receiving single-dose AMP who were at higher risk of SSI. In the prospective study (2161 patients), 546 patients weighing 80 kg or more who received only single-dose AMP had higher rates of all SSI types than a group of 1615 who received double-dose AMP (odds ratio (OR) 4.40, 95 per cent c.i. 3.18 to 6.23; P < 0.001). In multivariable analysis including 5021 patients from both cohorts, bodyweight (OR 1.01, 1.00 to 1.02; P = 0.008), BMI (OR 1.01, 1.00 to 1.02; P = 0.007) and double-dose AMP (OR 0.33, 0.23 to 0.46; P < 0.001) among other variables were independently associated with SSI rates. Conclusion Double-dose AMP decreases SSI rates in patients weighing 80 kg or more.

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

“…Currently, double-dose SAP administration has been shown to reduce SSI for patients weighing at least 120 kg, but all studies had sample sizes of less than 200 patients . In line with these findings, preliminary data suggest a role of double-dose SAP in reducing the SSI rate in patients who weigh at least 80 kg . Nevertheless, in most guidelines for SSI prevention, the issue of weight-adjusted SAP dosing is still considered unresolved …”

“…27 Our results did not confirm a preliminary study that suggested an approximately 4-fold lower SSI risk among patients weighing at least 80 kg who received a double cefuroxime dose. 16 The 4-fold lower rate is unlikely to be physiological, and therefore, previous studies may not have corrected for significant, unrecognized bias.…”

“…[11][12][13][14][15] In line with these findings, preliminary data suggest a role of double-dose SAP in reducing the SSI rate in patients who weigh at least 80 kg. 16 Nevertheless, in most guidelines for SSI prevention, the issue of weight-adjusted SAP dosing is still considered unresolved. [4][5][6][7][8] Even after the introduction of a nationwide SSI surveillance program, the Swiss SSI rate remained at an elevated level compared with results from other national surveillance programs.…”

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

“…108 Adjust dosing based on patient weight, 73 according to the following examples: For cefazolin, use 30–40 mg/kg for pediatric patients, use 2 grams for patients weighing ≤120 kg, and 3 grams for patients weighing >120 kg. 109,110 Although data are conflicting regarding the role of 3 grams of cefazolin dosing in reducing SSI in obese patients, multiple studies have shown a benefit compared to 2-gram dosing in this patient population, 110–112 with few adverse events from a single dose of 3 grams versus 2 grams of cefazolin. Although some hospitals use 1 gram for adult patients weighing ≤80 kg, there is no harm associated with giving a 2-gram dose. Dose vancomycin at 15 mg/kg.…”

Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue-only wrist arthroscopy

“…A larger study population would have probably identified known risk factors for SSI, such as BMI or ASA score. [46][47][48] Indeed, a major limitation of this study is the relatively small number of cases compared to the very low incidence of the observed SSI. Thus, we observed no SSI in the PAP or control group.…”