Abstract
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. To assess whether double-dose cefuroxime SAP was associated with a decreased SSI rate in patients weighing at least 80 kg. 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. Cefuroxime SAP dose (1.5 vs 3.0 g). Overall 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. Of 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 (≥90 to <100 kg, 10 342 patients: aOR, 1.12; 95% CI, 0.87-1.47; P = .37; ≥100 to <120 kg, 8099 patients: aOR, 0.99; 95% CI, 0.76-1.30; P = .96; ≥120 kg, 2594 patients: aOR, 0.65; 95% CI, 0.42-1.04; P = .06). After stratification by contamination class, double-dose SAP was associated with lower SSI rates among 1946 patients with contaminated wounds (aOR, 0.49; 95% CI, 0.30-0.84; P = .008) but not those with clean wounds (25 680 patients; aOR, 0.92; 95% CI, 0.76-1.12; P = .44) or clean-contaminated wounds (10 014 patients; aOR, 0.90; 95% CI, 0.73-1.12; P = .37) compared with a single dose. In this study, double-dose SAP with cefuroxime for patients weighing at least 80 kg was not consistently associated with a lower SSI rate.
Highlights
Surgical site infections (SSIs) account for approximately 20% of all health care–associated infections[1,2] and have a major impact on morbidity and mortality.[3,4] Several national and international guidelines provide evidenced-based measures to reduce surgical site infection (SSI) risk
Double-dose cefuroxime was administered to 13 246 patients (35.2%) and was not significantly associated with a lower SSI rate
After stratification by weight category, double-dose Surgical antimicrobial prophylaxis (SAP) vs single-dose SAP was associated with lower SSI rates among 16 605 patients weighing at least 80 to less than 90 kg but not in the other weight categories (Ն90 to
Summary
Surgical site infections (SSIs) account for approximately 20% of all health care–associated infections[1,2] and have a major impact on morbidity and mortality.[3,4] Several national and international guidelines provide evidenced-based measures to reduce SSI risk. Surgical antimicrobial prophylaxis (SAP) administration, its correct timing, and redosing have been identified as critical items for SSI prevention.[4,5,6,7,8]. While weight-adapted application of antimicrobial agents has been implemented in some infectious disease areas,[9,10] this practice has not been widely implemented for SSI prevention.[4,5,6,7,8] 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.[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] in most guidelines for SSI prevention, the issue of weight-adjusted SAP dosing is still considered unresolved.[4,5,6,7,8]
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