Among patients weighing 80 kg or more, surgical antimicrobial prophylaxis (SAP) with a double-dose of cefuroxime was not consistently associated with a decreased rate of surgical site infections (SSI), according to results of a study published in JAMA Network Open.
In this multicenter cohort study conducted between January 2015 and December 2019, researchers enrolled adult patients weighing at least 80 kg who underwent a major surgical procedure and received SAP with cefuroxime. The researchers sought to determine whether SAP with a double-dose of cefuroxime decreases the risk for SSI among these patients. The primary outcome was the occurrence of a SSI, and the researchers used a mixed-effects logistic regression model with adjustments for institutional, epidemiologic, and perioperative variables to analyze data captured from patients included in the study. The follow-up duration was 30 days for patients who underwent a surgical procedure and 1 year for those who underwent an implant-related procedure. In addition, results were stratified by patient weight categories and wound contamination classes.
Among a total of 37,640 patients included in the final analysis, the mean age was 61.9 (IQR, 49.9-71.1) years, and 60.1% were men. Of these patients, 24,394 (65%) received a single-dose of cefuroxime (1.5 g) and 13,246 (35%) received a double-dose of cefuroxime (3.0 g).
The overall SSI rate was 3.1% (n=747) and 3.5% (n=462) among patients who received a double-dose vs those who received a single-dose of cefuroxime, respectively. Of note, the researchers found no significant association between patients who received a double-dose of cefuroxime and a decreased SSI rate (adjusted odds ratio [aOR], 0.89; 95% CI, 0.78-1.02; P =.10). However, after stratification by weight, the researchers found that SSI rates were decreased among patients weighing 80 to 89 kg who received a double-dose of cefuroxime vs those who received a single-dose (aOR, 0.76; 95% CI, 0.61-0.97; P =.02). On analysis of patients included in other weight categories, the researchers found a significant association between a double-dose of cefuroxime and a decreased SSI rate among those weighing either 90 to 99 kg (aOR, 1.12; 95% CI, 0.87-1.47; P = .37), 100 to 119 kg (aOR, 0.99; 95% CI, 0.76-1.30; P =.96), or 120 kg or more (aOR, 0.65; 95% CI, 0.42-1.04; P =.06).
After stratification by wound contamination class, a double-dose of cefuroxime was found to be associated with a decreased SSI rate among patients with contaminated wounds (aOR, 0.49; 95% CI, 0.30-0.94; P =.008) but not among those with either clean wounds (aOR, 0.92; 95% CI, 0.76-1.12; P =.44) or clean-contaminated wounds (aOR, 0.90; 95% CI, 0.73-1.12; P =.37). In a subgroup analysis that excluded patients who underwent an implant-related procedure, a double-dose of cefuroxime was significantly associated with a decreased risk for SSI (aOR, 0.83; 95% CI, 0.69-0.99; P =.04).
This study was limited by the lack of information on patient comorbidities and characteristics, including diabetes, smoking status, nutrition status, intraoperative temperature, oxygen measurements, and continued use of antimicrobial prophylaxis. In addition, the study results were potentially biased by the inclusion of patients who underwent implant-related procedures with a follow-up period of 1 year.
According to the researchers, “the [decreased] SSI rate within the weight category of 80 to less than 90 kg, for contaminated wound class, and for surgical procedures without implants merits further investigation.”
Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Sommerstein R, Atkinson A, Kuster SP, et al. Association between antimicrobial prophylaxis with double-dose cefuroxime and surgical site infections in patients weighing 80 kg or more. JAMA Netw Open. Published online December 15, 2021. doi:10.1001/jamanetworkopen.2021.38926