Intraoperative Redosing of Surgical Antibiotic Prophylaxis in Addition to Preoperative Prophylaxis Versus Single-dose Prophylaxis for the Prevention of Surgical Site Infection

Abstract

The aim of this study was to determine the effect of preoperative surgical antibiotic prophylaxis (SAP) with additional intraoperative redosing compared to single-dose preoperative surgical antibiotic prophylaxis on the incidence of surgical site infections (SSI). Summary Background Data: Preoperative SAP is standard care for the prevention of SSI. During long surgical procedures, additional intraoperative redosing of SAP is advised, but there is great variability in redosing strategies and compliance rates. Methods: We performed a systematic search of MEDLINE (PubMed), Embase, CINAHL and CENTRAL on June 25 th , 2021 according to PROS-PERO registration CRD42021229035. We included studies that compared the effect of preoperative SAP with additional intraoperative redosing to single dose preoperative SAP (no redosing) on SSI incidence in patients undergoing any type of surgery. Two researchers performed data appraisal and extraction of summary data independently. Meta-analyses were stratified per study type. We used a generic inverse variance random-effects model to estimate a pooled odds ratio with corresponding 95% confidence intervals (CIs).Results: We included 2 randomized controlled trials (RCT) and 8 cohort studies comprising of 9470 patients. Pooled odds ratios for SSI in patients receiving intraoperative redosing compared to those without redosing were 0.47 (95% CI: 0.19-1.16. I 2 ¼ 36%) for RCTs and 0.55 (95% CI: 0.38-0.79, I 2 ¼ 56%) for observational cohorts. There was considerable clinical heterogeneity among antibiotics used and redosing protocols. GRADE-assessment showed overall low certainty of evidence. Conclusion: Intraoperative redosing of SAP may reduce incidence of SSI compared to a single dose preoperative SAP in any type of surgery, based on studies with considerable heterogeneity of antibiotic regimens and redosing protocols.

Surgical and procedural antibiotic prophylaxis in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

“… 30 31 Intraoperative redosing of surgical antibiotic prophylaxis has also been associated with a reduction in SSI in a broad range of surgical procedures, but no studies have directly compared intraoperative dosing versus no redosing for spinal surgery. 32 The NASS, the Spine Intervention Society (SIS), and the Infectious Disease Society of America (IDSA) all recommend redosing antibiotics if the duration of the procedure exceeds two half-lives of the drug or in the setting of excessive blood loss. 14 Therefore, we recommend a preoperative dose of antibiotics with intraoperative redosing as needed for non-instrumented spine surgery.…”

Analysis of Italian requests for compensation in cases of responsibility for healthcare-related infections: A retrospective study

“…According to current literature, the antibiotic should be administered intravenously within 60–120' before skin incision, in order to achieve adequate blood and tissue concentration during surgical procedure, considering half-life of molecules ( 25 ). In this regard, antibiotic redosing during surgical intervention lasting more than 2 times the half-life of drug is effective in lowering risk of SSI ( 26 ). In addition, the combination of oral and intravenous antibiotic prophylaxis has shown to be a viable approach in reducing rate of SSI in colorectal elective surgery ( 27 ).…”

Meta-Analysis of Clinical Trials Comparing Cefazolin to Cefuroxime, Ceftriaxone, and Cefamandole for Surgical Site Infection Prevention

“…According to Ahmed et al, cefazolin is the antibiotic of choice for prophylaxis in the majority of surgeries because it has been widely investigated and has established efficacy [ 48 ]. Wolfhagen et al stated that cefazolin is the most commonly indicated drug for surgical antibiotic prophylaxis [ 49 ]. Furthermore, according to Isserman et al, cefazolin, a first-generation cephalosporin, is the most often recommended antibiotic for perioperative prophylaxis to decrease surgical site infections [ 50 ].…”