Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections: Results From the Trial to Reduce Antimicrobial Prophylaxis Errors Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). A collaborative intervention to improve surgical antibiotic prophylaxis in children: results from a prospective multicenter study A Randomized, Double-blinded Placebo-controlled Clinical Trial of the Routine Use of Preoperative Antibiotic Prophylaxis in Modified Radical Mastectomy Oral Antibiotics Versus Topical Decolonization to Prevent Surgical Site Infection After Mohs Micrographic Surgery—a Randomized, Controlled Trial Should antibiotic prophylaxis be used routinely in clean surgical procedures: a tentative yes. Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Antibiotic regimen and the timing of prophylaxis are important for reducing surgical site infection after elective abdominal colorectal surgery. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand Standardized incidence rates of surgical site infection: a multicenter study in Thailand. Determinants of surgical site infection after breast surgery.
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 prospect ively obtained information on AMP from 4472 r and omly 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 OBJECTIVE To evaluate the risk factors for surgical site infection ( SSI ) after gastric surgery in patients in Korea . DESIGN A nationwide prospect i ve multicenter study . SETTING Twenty university-affiliated hospitals in Korea . METHODS The Korean Nosocomial Infections Surveillance System ( KONIS ) , a Web-based system , was developed . Patients in 20 Korean hospitals from 2007 to 2009 were prospect ively monitored for SSI for up to 30 days after gastric surgery .  Demographic data , hospital characteristics , and potential perioperative risk factors were collected and analyzed , using multivariate logistic regression models . RESULTS Of the 4,238 case patients monitored , 64.9 % ( 2,752 ) were male , and mean age ( ± SD ) was 58.8 ( ± 12.3 ) years .  The SSI rates were 2.92 , 6.45 , and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0 , 1 , and 2 or 3 , respectively . The majority ( 69.4 % ) of the SSIs observed were organ or space SSIs . The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae . Male sex ( odds ratio [ OR ] , 1.67 [ 95 % confidence interval ( CI ) , 1.09 - 2.58 ] ) , increased operation time ( 1.20 [ 1.07 - 1.34 ] per 1-hour increase ) , reoperation ( 7.27 [ 3.68 - 14.38 ] ) , combined multiple procedures ( 1.79 [ 1.13 - 2.83 ] ) , prophylactic administration of the first antibiotic dose after skin incision ( 3.00 [ 1.09 - 8.23 ] ) , and prolonged duration ( ≥7 days ) of surgical antibiotic prophylaxis ( SAP ; 2.70 [ 1.26 - 5.64 ] ) were independently associated with increased risk of SSI . CONCLUSIONS Male sex , inappropriate SAP , and operation-related variables are independent risk factors for SSI after gastric surgery Purpose The use of surgical antibiotic prophylaxis ( SAP ) in children is poorly characterized . Our aim was to evaluate the effectiveness of a quality improvement ( QI ) intervention targeting  SAP in children , by means of a multicenter prospect i ve intervention study , with a before and after design . Methods We prospect ively investigated elective surgical procedures performed in children < 18 years , prior to the QI intervention  , after the intervention and at 9-month follow-up . The primary outcomes were adherence to SAP indications and SAP appropriateness , defined considering antibiotic choice , timing of first dose and duration of administration . We compared SAP adherence and appropriateness prior the QI intervention , to the post-intervention and the follow-up . We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness . Results We collected information on 2383 procedures ( pre-intervention : 784 ; post-intervention : 790 ; follow-up : 809 ) . The QI intervention had a significant impact on the adherence to SAP indications ( 86.6 % in the post-intervention , compared to 82.0 % prior to the intervention ; p < 0.05 ) , and on its appropriateness ( 35.7 % compared to 19.9 % ; p < 0.01 ) . The impact of the intervention on SAP appropriateness was maintained at follow-up ( 38.3 % ; p < 0.01 compared to pre-intervention ) . All components of SAP appropriateness significantly improved after the intervention and at follow-up . The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness . Conclusions Following the QI intervention , there was a significant improvement in quality of SAP in pediatric surgery , though more efforts are needed to increase SAP appropriateness Background The effectiveness of antibiotic prophylaxis for prevention of surgical site infection ( SSI ) following specific types of breast cancer surgery remains uncertain . This study assessed the effectiveness of prophylaxis in modified radical mastectomy  ( MRM ) . Methods Women undergoing MRM for breast cancer were recruited . Women were excluded who had diabetes mellitus , severe malnutrition or known allergy to cephalosporins ; were receiving corticosteroid therapy or were treated with antibiotics within one week prior to surgery ; were scheduled for simultaneous breast reconstruction or bilateral oophorectomy ; had existing local infection . Participants were r and omized to receive either intravenous cefazolin 1 g or placebo within 30 min prior to skin incision . St and ard skin preparation and operative technique for MRM were carried out . Wounds were assessed for SSI and other complications weekly for 30 days . Results A total of 254 women were recruited . Age , clinical stage , prior chemotherapy , and operative time were similar for antibiotic and placebo groups . The overall incidence of SSI was 14.2 % . There were no significant differences in the infection rate over the 30-day follow-up period between the placebo and antibiotic groups ( 15 % vs 13.4 % ; p = 0.719 ) or at each week . The majority of SSI were either cellulitis or superficial infection for both groups . There were no significant differences between groups in treatments required for SSI , incidence of hematoma or seroma . Conclusions The findings of this study , alone and when meta-analyzed with data from studies in similar surgical population s , do not support the use of antibiotic prophylaxis in MRM BACKGROUND The optimal method of reducing the risk of surgical site infection ( SSI ) after dermatologic surgery is unclear . Empiric , preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI . Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers . We compared the rates of infection in patients undergoing Mohs micrographic surgery ( MMS ) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization .  METHODS A r and omized , controlled trial with 693 patients was conducted over a 30‐week period at a single surgical practice . Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab . Nasal carriers of S. aureus were r and omized to receive topical decolonization with intranasal mupirocin twice daily plus 4 % chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre‐ and postoperative doses of oral cephalexin . RESULTS One hundred seventy‐nine patients ( 25.8 % ) were identified as carriers of S. aureus . Ninety received topical decolonization , and 89 received oral antibiotics . These groups were compared with a swab‐negative Mohs surgical cohort over the same time period . There were no significant differences between the groups in terms of demographic characteristics or comorbidities . Nine percent of patients receiving oral antibiotic prophylaxis and 0 % receiving topical decolonization developed early SSI ( p = .003 ) . CONCLUSION In patients with demonstrable carriage of S. aureus , topical decolonization result ed in fewer SSI than in patients receiving perioperative oral antibiotics . Antibiotics should be reserved for clinical ly suspected and swab‐proven infections rather than being prescribed empirically . Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS BACKGROUND The incidence of  surgical site infection ( SSI )  after clean surgical procedure has traditionally been regarded as too low for routine antibiotic prophylaxis . But we now know that host factors may increase the risk of SSI to as high as 20 % . We assessed the value of prophylactic cefotaxime in patients stratified for risk of SSI in a r and omized double-blind trial . METHODS Patients admitted for clean elective operations were enrolled , stratified for risk by National Nosocomial Infection Survey criteria , and r and omized to receive intravenous cefotaxime 2 gm or placebo  on call for operation . They were followed for 4 to 6 weeks for SSI diagnosed by Centers for Disease Control and Prevention criteria . RESULTS Analysis of 775 patients showed that the 378 evaluable patients who received cefotaxime had 70 % fewer SSI than those who did not -- Mantel-Haenszel risk ratio ( MH-RR ) 0.31 ; 95 % confidence intervals ( CI ) 0.11 to 0.83 . Benefit was clear in the 616 low risk patients --0.97 % versus 3.9 % SSI ( MH-RR 0.25 , CI 0.07 to 0.87 , p = 0.018 ) , but only a trend was seen in 136 high risk patients --2.8 % versus 6.1 % SSI ( MH-RR 0.48 , CI 0.09 to 2.5 ) . CONCLUSIONS The results indicate clear benefit for routine antibiotic prophylaxis in clean surgical procedures . High risk patients need more study BACKGROUND Surgical site infections ( SSIs ) following total hip arthroplasty can lead to prolonged hospitalization , increased morbidity and mortality , and high costs . This article analyzes the effect of various parameters of surgical antibiotic prophylaxis on the risk of SSI following total hip arthroplasty . METHODS Data about SSI and potential prophylaxis- , patient- , and procedure-related risk factors were prospect ively collected for 1922 patients who underwent elective total hip arthroplasty in 11 hospitals that participated in the Dutch intervention project , Surgical Prophylaxis and Surveillance .  Multivariate logistic regression analysis was performed to correct for r and om variation among hospitals . RESULTS SSIs ( superficial and deep ) occurred in 50 patients ( 2.6 % ) . The highest odds ratios for SSI were found in patients who received prophylaxis after incision ( 2.8 , 95 % confidence interval [ CI ] , 0.9 - 8.6 ; P=.07 ) , had an American Society of Anesthesiology score that was > 2 ( 2.8 , 95 % CI , 0.8 - 9.2 ; P=.09 ) , and experienced a duration of surgery that was > 75th percentile ( 2.5 ; 95 % CI , 1.1 - 5.8 ; P=.04 ) . Prolonged prophylaxis after the end of surgery and the use of antibiotic-impregnated cement did not contribute to fewer SSIs in this study . CONCLUSIONS This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis BACKGROUND Surgical site infections ( SSIs ) cause morbidity after elective colorectal surgery , and antibiotic prophylaxis can decrease SSIs . The aim of this study was to determine compliance with an antibiotic administration protocol , including regimen , initial dose timing , and re-dosing , and determine the risk of SSI associated with each . We hypothesized that appropriate antibiotic administration reduces the risk of SSI . METHODS Retrospective review from a prospect i ve data base of a r and om sample of patients undergoing elective abdominal colorectal procedures with anastomosis .  Antibiotic regimens , initial dose timing ( IDT ) , and re-dosing were evaluated . Appropriate regimens covered gram-positive cocci , gram-negative bacilli , and anaerobes . The IDT was considered proper if completed within 30 min prior to incision ; re-dosing parameters were determined pharmacokinetically for each agent . The main outcome was SSI . Sequential logistic models were generated : Model 1 assessed antibiotic administration factors , whereas Model 2 controlled for patient and clinical factors , including disease process , patient characteristics , intra-operative factors , and post-operative factors . RESULTS Six hundred five patients ( mean age 59.7 [ st and ard deviation 17.8 ] years , 42.8 % male ) were included . The most common diagnoses were cancer ( 38.8 % ) and inflammatory bowel disease ( 22.0 % ) . Seventy-six patients ( 12.6 % ) had superficial or deep incisional SSI , and 54 ( 8.9 % ) had organ/space SSI . Regimens included cefazolin + metronidazole for 219 patients ( 36.2 % ) , cefoxitin for 214 ( 35.4 % ) , and levofloxacin + metronidazole for 48 ( 7.9 % ) . One hundred fourteen patients ( 18.8 % ) received other/nonst and ard regimens , and ten had no documented antibiotic prophylaxis . Fifty-five patients ( 9.1 % ) received insufficient coverage , whereas 361 patients ( 59.7 % ) had proper IDT , and 401 regimens ( 66.3 % ) were re-dosed properly . In Model 1 , the use of other/nonst and ard regimens ( odds ratio [ OR ] 2.069 ; 95 % confidence interval [ CI ] 1.078 - 1.868 ) and early administration of the initial prophylaxis dose ( OR 1.725 ; 95 % CI 1.147 - 2.596 ) were associated with greater odds of SSI . After adding clinical factors in Model 2 , both of these factors remained significant ( OR 2.505 ; 95 % CI 1.066 - 5.886 and OR 1.733 ; 95 % CI 1.017 - 2.954 , respectively ) . CONCLUSIONS Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of SSI after elective colorectal surgery with intestinal anastomosis BACKGROUND  Laparoscopic cholecystectomy ( LC ) is the gold st and ard for the treatment of symptomatic gallbladder stones . As infections are rare in uncomplicated LC , it is widely accepted that prophylactic antibiotics need not be administered , and guidelines do not support routine antibiotic prophylaxis during elective LC . However , routine antibiotic prophylaxis for elective LC is still popular in many clinical setting s. We investigated this situation in our department . METHOD This r and omized double-blind controlled study included 570 patients who underwent LC between March 2007 and February 2010 . The exclusion criteria were antibiotic intake before surgery , steroid treatment , and the presence of pancreatitis , cholangitis , obstructive jaundice , cephalosporin allergy , or pregnancy . The patients were r and omized into three groups . Group 1 ( n = 193 ) received physiologic saline as placebo , Group 2 ( n = 191 ) received a first-generation cephalosporin ( cefazolin ; 1 g ) , and Group 3 ( n = 186 ) received a second-generation cephalosporin ( cefuroksim aksetil ; 750 mg ) . Bile and epigastric and umbilical port tissue sample s were harvested for culture . All patients were observed until the end of the fourth week after surgery . Patient age , sex , weight , American Society of Anesthesiologists ( ASA ) score , diabetes mellitus , smoking history , history of biliary colic in the past month , length of the hospital stay before the operation , operational findings ( acute or chronic cholecystitis ) , operation duration , use of drainage , type of prophylaxis administered if any , culture results , surgical site infection ( SSI ) development , and time to SSI development along with associated treatments were evaluated . RESULTS There was no statistically significant difference between the groups with respect to any of the demographic and clinical features analyzed in this study . The SSI rate was 1.2 % in total , and in Groups 1 , 2 , and 3 , it was 1.5 % , 1.04 % , and 1.07 % , respectively . There was no statistical difference regarding SSI among the groups ( p = 1.00 ) . Superficial SSI was observed in all groups , and in all patients , the site of infection was the entrance to the epigastric port through which the gallbladder had been removed . CONCLUSIONS Surgical site infection is rare after LC , and antibiotic prophylaxis does not appear to affect the outcome significantly . Moreover , factors such as positive bile cultures , history of biliary attack , ASA score , diabetes , obesity , and smoking do not have any effect on SSI development . Thus , we conclude that antibiotic prophylaxis is not needed for elective LC Background A prophylactic antibiotic is recommended in open cholecystectomy surgeries , but in laparoscopic cholecystectomies such prophylaxis is controversial . Recent review s have not found conclusive evidence that routine prophylaxis , especially in low risk patients , is effective . This clinical trial was undertaken to evaluate the efficacy of cefazolin in reducing surgical site infection SSI in laparoscopic cholecystectomies in a sample not screened for high or low risk patients . Methods A r and omized double-blind controlled trial was conducted in a single university hospital . Scheduled cholecystectomy patients without selection for patient risk factors were r and omized into two groups . Pre-operatively , group A patients received a placebo of 10 ml isotonic sodium chloride , and group B patients received 1 g of cefazolin as a prophylactic antibiotic . All patients underwent a st and ard laparoscopic cholecystectomy , and were followed up for at least 30 days . Results Two hundred ninety-nine patients were r and omized ( 149 in group A and 150 in group B ) .  SSI occurred in seven patients ( 2.34 % ) , five ( 1.67 % ) in the placebo group , and two ( 0.67 % ) in the prophylactic antibiotic group . The difference was not statistically significant ( p value = 0.512 ) , and no specific risk factors for post-operative infection were identified . Conclusions A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy . Whether or not to use a prophylactic depends on the individual patient , and the consideration of the attending surgeon Background No data currently exist about use of antibiotics to prevent surgical site infections ( SSI )  among patients undergoing appendectomy in Thail and . We therefore examined risk factors , use , and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy . Methods From July 1 , 2003 to June 30 , 2004 we conducted a prospect i ve cohort study in eight hospitals in Thail and . We used the National Nosocomial Infection Surveillance ( NNIS ) system criteria to identify SSI associated with appendectomy . We used logistic regression analysis to obtain relative risk estimates for predictors of SSI . Results Among 2139 appendectomy patients , we identified 26 SSIs , yielding a SSI rate of 1.2 infections/100 operations . Ninety-two percent of all patients ( 95 % CI , 91.0–93.3 ) received antibiotic prophylaxis . Metronidazole and gentamicin were the two most common antibiotic agents , with a combined single dose administered in 39 % of cases . In 54 % of cases , antibiotic prophylaxis was administered for one day . We found that a prolonged duration of operation was significantly associated with an increased SSI risk . Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively . Compared with no antibiotic prophylaxis , SSI relative risks for combined single-dose of metronidazole and gentamicin , one-day prophylaxis , and multiple-day antibiotic prophylaxis were 0.28 ( 0.09–0.90 ) , 0.30 ( 0.11–0.88 ) and 0.32 ( 0.10–0.98 ) , respectively . ConclusionS ingle-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing from SSI at the national level could not be assessed . The purpose of this study was to estimate the incidence of SSI in 9 hospitals , together with patterns of surgical antibiotic prophylaxis , risk factors for SSI , and common causative pathogens . METHODS A prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and was conducted . The National Nosocomial Infection Surveillance ( NNIS ) system criteria and method were used for identifying and diagnosing SSI . The SSI rates were benchmarked with the NNIS report by means of indirect st and ardization and reported in terms of st and ardized infection ratio ( SIR ) . Antibiotic prophylaxis was categorized into preoperative , intraoperative , and postoperative . Risk factors for SSI were evaluated using multiple logistic regression models . RESULTS From July 1 , 2003 , to February 29 , 2004 , the study included 8764 patients with 8854 major operations and identified 127 SSIs , yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 ( 95 % CI : 0.5 - 0.8 ) . Of these , 35 SSIs ( 27.6 % ) were detected postdischarge . The 3 most common operative procedures were cesarean section , appendectomy , and hysterectomy . The 3 most common pathogens isolated were Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa , which accounted for 15.3 % , 8.5 % , and 6.8 % of infections , respectively . The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin , cefazolin , and gentamicin . The proportion of types of antibiotic prophylaxis administered were 51.6 % preoperative , 24.3 % intraoperative , and 24.1 % postoperative . Factors significantly associated with SSI were high degree of wound contamination , prolonged preoperative hospital stay , emergency operation , and prolonged duration of operation . CONCLUSION Overall SSI rates were less than the average NNIS rates . The causative pathogens of SSI were different from those of other reports . There was a crucial proportion of operations that did not comply with the antibiotic guidelines . The risk factors for SSI identified in this study were consistent with most other reports BACKGROUND Surgical site infection ( SSI )  after breast procedures may result in significant morbidity , psychologic trauma , and additional cost , SSI rates in patients at the Clevel and Clinic Foundation having biopsy , partial mastectomy , or modified radical mastectomy were higher during April and May 1995 than during the previous 12 months ( 8 infections for 74 procedures [ 10.8 % ] vs 10 for 378 [ 2.6 % ] ; p < 0.006 ) . Since 1993 one surgeon has performed most of these procedures , with no change in operative technique , skin preparation , or surgical team . A case-control study was performed to identify risk factors for infection . METHODS A case patient was defined as any patient having a breast procedure from April 1994 through May 1995 with culture of a pathogen from surgical site drainage or aspiration or with erythema or presence of cellulitis treated by incision and drainage and /or antibiotic therapy . R and omly selected control patients were matched by time and procedure . There were 18 case patients and 37 control patients . RESULTS Factors associated with SSI were obesity ( 78 % of cases vs 40 % of controls ; p = 0.02 ) and older age ( mean 66 years in cases vs 56 years in controls ; p = 0.005 ) . After introduction of cefazolin sodium prophylaxis , SSI rate was reduced to 0.9 % ( 3 infections for 332 procedures ) . CONCLUSIONS Host factors may contribute to SSI in breast procedures . Cefazolin sodium prophylaxis was useful in preventing SSI after breast surgery
Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision .
Abstract The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis ( SAP ) on  surgical site infection ( SSI )  and compare the different timing intervals .
The benefit of routine use of SAP prior to surgery has long been recognized .
However , the optimal timing has not been defined .