Increased Use of Postoperative Surgical Antimicrobial Prophylaxis is not Correlated with Reduced Surgical Site Infection Rates at the Hospital Level: Results from the ACS NSQIP-Pediatric Antimicrobial Stewardship Collaborative
Katherine He, MD, MS1, Marie Iwaniuk, PhD2, Michael J Goretsky, MD3, Robert A Cina, MD4, Jacqueline M Saito, MD, MSCI5, Bruce Hall, MD, PhD, MBA5, Catherine Grant, BSN, RN2, Mark E Cohen, PhD2, Shawn J. Rangel, MD, MSCE1
1Boston Children’s Hospital, Boston, MA; 2American College of Surgeons, Chicago, IL; 3Children’s Hospital of the King’s Daughters, Norfolk, VA; 4The Medical University of South Carolina, Charlestown, SC; 5Washington University St. Louis School of Medicine, St. Louis, MI
Background: Despite great practice variation, routine postoperative continuation of surgical antimicrobial prophylaxis is not recommended by consensus guidelines. We explored hospital-level correlation between postoperative prophylaxis and surgical site infection (SSI) rates for non-emergent general pediatric surgical conditions.
Methods: From 6/2019-6/2020, 90 hospitals participating in an American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric) antibiotic stewardship collaborative collected prophylaxis and SSI data for non-emergent surgeries. Exclusion criteria included penicillin/cephalosporin allergies, immunocompromised status, and pre-existing infection. Prophylaxis measures included any postoperative utilization and prolonged postoperative use >24 hours. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for each measure, adjusting for procedure-mix and comorbidities. The Pearson correlation coefficient was used to explore the relationship between each prophylaxis utilization measure and SSIs.
Results: Of 10398 patients, 19.2% received postoperative prophylaxis and 6.1% received postoperative antibiotics >24 hours. Postoperative prophylaxis was common for pectus repair (61.7%), colorectal procedures (51.9%), and esophageal atresia/tracheoesophageal fistula repair (EA/TEF) (51.0%). Prophylaxis >24 hours was common for colorectal procedures (21.4%), pectus repair (20.9%), and EA/TEF repair (15.7%). Following adjustment, there was poor correlation between SSIs and any postoperative antibiotic utilization (R-squared 0.028, p=0.79) and prolonged utilization >24 hours (R-squared -0.11, p=0.30) (Figure).
Conclusion: Following adjustment, prolonged antimicrobial prophylaxis was not correlated with fewer SSIs, suggesting targeted antimicrobial stewardship efforts to reduce prolonged utilization would not increase SSI rates.
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