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Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients.
Surg Infect (Larchmt). 2018 May/Jun; 19(4):388-396.SI

Abstract

BACKGROUND

Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines. A sub-group analysis investigated whether prophylaxis with cefazolin plus metronidazole was associated with a lower rate of surgical site infections (SSIs) versus cefotetan.

PATIENTS AND METHODS

This retrospective cohort study included adult inpatients who underwent an abdominal surgery at JHH in September 2015 (Study Period I: cefotetan) or February to March 2016 (Study Period II: cefazolin plus metronidazole).

RESULTS

Two hundred abdominal surgery cases were included in the primary analysis. A subset of 156 surgical cases were included in the sub-group analysis. The overall adherence rate to JHH guidelines was 75% in Study Period I versus 17% in Study Period II (p < 0.001). The largest difference in adherence was attributed to pre-operative administration time (87% vs. 23%, p < 0.001), primarily because of the longer infusion time required for metronidazole. Surgical site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19).

CONCLUSIONS

Adherence to an institution-specific peri-operative antibiotic prophylaxis guideline for abdominal surgeries was limited primarily by the longer infusion time required for pre-operative metronidazole. A higher percentage of SSIs occurred among abdominal surgeries with cefotetan versus cefazolin plus metronidazole for prophylaxis.

Authors+Show Affiliations

1 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.2 Department of Pharmacy, Orlando Regional Medical Center , Orlando, Florida.1 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.1 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland. 3 Antimicrobial Stewardship Program, The Johns Hopkins Hospital , Baltimore, Maryland.4 Departments of Surgery, Anesthesiology, Critical Care Medicine , and Nursing, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland.5 Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital , Baltimore, Maryland.1 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29688837

Citation

Danan, Eleanor, et al. "Use and Effectiveness of Peri-Operative Cefotetan Versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients." Surgical Infections, vol. 19, no. 4, 2018, pp. 388-396.
Danan E, Smith J, Kruer RM, et al. Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients. Surg Infect (Larchmt). 2018;19(4):388-396.
Danan, E., Smith, J., Kruer, R. M., Avdic, E., Lipsett, P., Curless, M. S., & Jarrell, A. S. (2018). Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients. Surgical Infections, 19(4), 388-396. https://doi.org/10.1089/sur.2018.010
Danan E, et al. Use and Effectiveness of Peri-Operative Cefotetan Versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients. Surg Infect (Larchmt). 2018 May/Jun;19(4):388-396. PubMed PMID: 29688837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients. AU - Danan,Eleanor, AU - Smith,Janessa, AU - Kruer,Rachel M, AU - Avdic,Edina, AU - Lipsett,Pamela, AU - Curless,Melanie S, AU - Jarrell,Andrew S, Y1 - 2018/04/24/ PY - 2018/4/25/pubmed PY - 2018/9/25/medline PY - 2018/4/25/entrez KW - abdominal KW - adherence KW - antibiotic KW - surgical prophylaxis KW - surgical site infection SP - 388 EP - 396 JF - Surgical infections JO - Surg Infect (Larchmt) VL - 19 IS - 4 N2 - BACKGROUND: Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines. A sub-group analysis investigated whether prophylaxis with cefazolin plus metronidazole was associated with a lower rate of surgical site infections (SSIs) versus cefotetan. PATIENTS AND METHODS: This retrospective cohort study included adult inpatients who underwent an abdominal surgery at JHH in September 2015 (Study Period I: cefotetan) or February to March 2016 (Study Period II: cefazolin plus metronidazole). RESULTS: Two hundred abdominal surgery cases were included in the primary analysis. A subset of 156 surgical cases were included in the sub-group analysis. The overall adherence rate to JHH guidelines was 75% in Study Period I versus 17% in Study Period II (p < 0.001). The largest difference in adherence was attributed to pre-operative administration time (87% vs. 23%, p < 0.001), primarily because of the longer infusion time required for metronidazole. Surgical site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19). CONCLUSIONS: Adherence to an institution-specific peri-operative antibiotic prophylaxis guideline for abdominal surgeries was limited primarily by the longer infusion time required for pre-operative metronidazole. A higher percentage of SSIs occurred among abdominal surgeries with cefotetan versus cefazolin plus metronidazole for prophylaxis. SN - 1557-8674 UR - https://www.unboundmedicine.com/medline/citation/29688837/Use_and_Effectiveness_of_Peri-Operative_Cefotetan_versus_Cefazolin_Plus_Metronidazole_for_Prevention_of_Surgical_Site_Infection_in_Abdominal_Surgery_Patients L2 - https://www.liebertpub.com/doi/full/10.1089/sur.2018.010?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -