BOSTON – A review of patients treated at a hospital in Wichita, KS showed that postoperative antibiotic prophylaxis did not reduce rates of surgical site infection rates.
Guidelines from the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America (IDSA/SHEA) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend against postoperative antibiotic prophylaxis, and some studies have shown that such antibiotics increases patients’ risk for C difficile. Wesley Medical Center, a 760-bed institution that performs about 1000 surgeries per month, stopped routine use of postoperative antibiotics in July 2014, leaving it to the physician’s discretion.
“Numerous studies have shown no benefit in continuing antibiotic prophylaxis postoperatively,” Stephanie Kuhn, PharmD, the hospital’s infectious diseases clinical pharmacist said at ASM Microbe. “We saw a similar rate of surgical site infections both pre- and post change with a similar number of Clostridium difficile infections.”
Dr Kuhn said researchers there wanted to compare rates of surgical site infections and incidence of C difficile infections in patients who received 24 to 48 hours of postoperative antibiotic prophylaxis vs patients who had surgery after Wesley discontinued the practice.
Patients who underwent surgery during August 2013 to January 2014 and August 2014-January 2015 were eligible for inclusion. There 905 surgeries during the antibiotic group and 697 in the non-antibiotic group. Overall, the rate of surgical site infections in both groups was 1.1%.
“We did not see any change in our overall number of health care-related Clostridium difficile infections,” Dr. Kuhn said. “When we broke this down to just our surgical patients who developed Clostridium difficile infections, there was a trend toward a lower number of CDIs in our post-process change.”
There were 39 cases of hospital-acquired C difficile infection at Wesley during both study periods. Among patients who underwent surgery, there were 15 C difficile infections in the antibiotic group and 11 in the non-antibiotic group.
1. Louis R, Kuhn S, Creswell V. Rates of surgical site infections and Clostridium difficile infections before and after the elimination of post-operative antibiotic prophylaxis at Wesley Medical Center. Paper presented at: ASM Microbe 2016. June 16-20, 2016; Boston.