Abstract
BackgroundAntibiotic surgical prophylaxis is a core strategy for prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. This study was designed to determine the individual perspectives of perioperative providers at an academic tertiary referral center regarding their knowledge of preoperative antibiotic choice, dosing, and timing.MethodsA prospective survey was conducted amongst surgical and anesthesia team members involved in preoperative antibiotic decision making. The survey addressed ten key principles relating to preoperative antibiotic use, including antibiotic choice, timing and rate of infusion, and dosing. The survey was distributed among orthopaedic surgeons, residents, and anesthesia providers at their respective monthly service line meetings between August 2017 to June 2019. The data was stored and analyzed in a Microsoft Excel worksheet.ResultsA total of 73 providers completed the survey. Twenty-two (30 %) of the providers agreed and 47 (64 %) disagreed that both vancomycin and cefazolin are equally effective for antibiotic prophylaxis. As for antibiotic choice in patients with penicillin allergies, 37 (51 %) agreed with vancomycin, 21 (29 %) agreed with clindamycin, and 15 (21 %) disagreed with both alternatives. When providers were surveyed regarding the appropriateness of standard versus weight adjusted dosing, 67 (92 %) agreed that vancomycin should be weight adjusted and 63 (86 %) agreed that cefazolin should be weight adjusted.ConclusionsThere is no clear consensus amongst providers for which antibiotic to administer for antibiotic prophylaxis despite existing guidelines. Discrepancy also exists between orthopaedic surgery and anesthesia providers in regards to appropriate antibiotic choice for patients with reported penicillin allergies. Institutions should implement evidence-based protocols for preoperative antibiotic prophylaxis and continue to prospectively monitor compliance in order to identify any inconsistencies that could result in inappropriate antibiotic prophylaxis for patients.
Highlights
Antibiotic surgical prophylaxis is a core strategy for prevention of surgical site infections (SSI)
A total of 3 providers (13 %) agreed that vancomycin and cefazolin are effective for antibiotic prophylaxis whereas 19 (79 %) disagreed, and 2 (8 %) were unsure (Fig. 2)
The results indicated barriers to its effectiveness as a suitable method for prophylaxis. 22 providers (92 %) agreed that vancomycin infusion at the time of incision does not allow for adequate concentrations for appropriate antibiotic prophylaxis
Summary
Antibiotic surgical prophylaxis is a core strategy for prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. Surgical site infections (SSI) continue to be one of the most common complications after orthopaedic surgery [1, 2]. One of the most important strategies to reduce the risk of SSI is antibiotic prophylaxis, with a goal of decreasing the overall burden of microorganisms at the operative site [5]. Since the most common pathogen associated with SSI in orthopaedic procedures is Methicillin-sensitive Staphylococcus aureus (MSSA), antibiotics with excellent gram-positive coverage, such as first or third generation cephalosporins are often preferred. Patient allergies, the side effect profile, and the cost associated with the antibiotic must be considered
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