Implementing 1-Dose Antibiotic Prophylaxis for Prevention of Surgical Site Infection | Clinical Pharmacy and Pharmacology | JAMA Surgery | JAMA Network
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1.
Burke  JF The effective period of preventive antibiotic action in experimental incisions and dermal lesions.  Surgery 1961;50161- 168PubMedGoogle Scholar
2.
 Antimicrobial prophylaxis in surgery. Abramowicz  M The Medical Letter on Drugs and Therapeutics 2001;43W1116- W1117Google Scholar
3.
 Antimicrobial prophylaxis in surgery [SIGN publication No. 45].  Scottish Intercollegiate Guideline Network Web site http://www.sign.ac.uk/guidelines/fulltext/45/index.html. Accessed August 22, 2006Google Scholar
4.
Ferraz  AABFerraz  EM Antibioticoprofilaxia em cirurgia. Marins  N Programa de atualização em uso de antibióticos em cirurgia Rio de Janeiro, Brazil Diagraphic Editora2002;Google Scholar
5.
Polk  HC  JrChristmas  B Prophylactic antibiotics in surgery and surgical wound infections.  Am Surg 2000;66105- 111PubMedGoogle Scholar
6.
Mangram  AJHoran  TCPearson  MLSilver  LCJarvis  WR Guidelines for prevention of surgical site infection, 1999.  Infect Control Hosp Epidemiol 1999;20250- 278PubMedGoogle ScholarCrossref
7.
Wong  ES Surgical site infections. Mayhall  CG Hospital Epidemiology and Infection Control Philadelphia, Pa Lippincott Williams & Wilkins1999;Google Scholar
8.
Gyssens  IC Preventing postoperative infections: current treatment recommendations.  Drugs 1999;57175- 185PubMedGoogle ScholarCrossref
9.
Maki  DGShuna  AA A study of antimicrobial misuse in a university hospital.  Am J Med Sci 1978;275271- 282PubMedGoogle ScholarCrossref
10.
Shapiro  MTownsend  TRRosner  BKass  EH Use of antimicrobial drugs in general hospitals: patterns of prophylaxis.  N Engl J Med 1979;301351- 355PubMedGoogle ScholarCrossref
11.
Moss  FMcSwiggan  DAMcNicol  MWMiller  DL Survey of antibiotic prescribing in a district general hospital, I: pattern of use.  Lancet 1981;2349- 352PubMedGoogle ScholarCrossref
12.
Classen  DCEvans  RSPestotnik  SLHorn  SDMenlove  RLBurke  OP The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.  N Engl J Med 1992;326281- 286PubMedGoogle ScholarCrossref
13.
Heineck  IFerreira  MBSchenkel  EP Prescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil.  Am J Infect Control 1999;27296- 300PubMedGoogle ScholarCrossref
14.
Bailly  PLallemand  SThouverez  MTalon  D Multicentre study on the appropriateness of surgical antibiotic prophylaxis.  J Hosp Infect 2001;49135- 138PubMedGoogle ScholarCrossref
15.
Hosoglu  SSunbul  MErol  S  et al.  A national survey of surgical antibiotic prophylaxis in Turkey.  Infect Control Hosp Epidemiol 2003;24758- 761PubMedGoogle ScholarCrossref
16.
Bedouch  PLabarère  JChirpaz  E  et al.  Compliance with guidelines of antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital.  Infect Control Hosp Epidemiol 2004;25302- 307PubMedGoogle ScholarCrossref
17.
Fonseca  SNSKunzle  SRMSilva  SABSchmidt  JG  JrMele  RR Cost reduction with successful implementation of an antibiotic prophylaxis program in a private hospital in Ribeirão Preto, Brazil.  Infect Control Hosp Epidemiol 1999;2077- 79PubMedGoogle ScholarCrossref
18.
Horan  TCGaynes  RPMartone  WJJarvis  WREmori  TG CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.  Infect Control Hosp Epidemiol 1992;13606- 608PubMedGoogle ScholarCrossref
19.
McClave  TJDietrich  FH Statistics.  San Francisco, Calif Dellen Publishing Co1985;
20.
Centers for Disease Control and Prevention, National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996: a report from the National Nosocomial Infections Surveillance (NNIS) system.  Am J Infect Control 1996;24380- 388PubMedGoogle ScholarCrossref
21.
Green  JWWenzel  RP Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization.  Ann Surg 1977;185264- 268PubMedGoogle ScholarCrossref
22.
Taylor  GJMikell  FLMoses  HWDove  JTKatholi  REMalik  SA Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications.  Am J Cardiol 1990;65309- 313PubMedGoogle ScholarCrossref
23.
McGarry  SAEngemann  JJSchmader  KSexton  DJKaye  KS Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost.  Infect Control Hosp Epidemiol 2004;25461- 467PubMedGoogle ScholarCrossref
24.
Perencevich  ENSands  KECosgrove  SEGuadagnoli  EMeara  EPlatt  R Health and economic impact of surgical site infections diagnosed after hospital discharge.  Emerg Infect Dis 2003;9196- 203PubMedGoogle ScholarCrossref
25.
McKibben  LHoran  TTokars  JI  et al. Healthcare Infection Control Practices Advisory Committee, Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee.  Am J Infect Control 2005;33217- 226PubMedGoogle ScholarCrossref
26.
Weed  HG Antimicrobial prophylaxis in the surgical patient.  Med Clin North Am 2003;8759- 75PubMedGoogle ScholarCrossref
27.
Quenon  JLEveillard  MVivien  A  et al.  Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis: a multicentre survey in private and public French hospitals.  J Hosp Infect 2004;56202- 207PubMedGoogle ScholarCrossref
28.
Caldwell  JRLeighton  EC Adverse reactions to antimicrobial agents.  JAMA 1974;23077- 80PubMedGoogle ScholarCrossref
29.
Patterson  JE Antibiotic utilization: is there an effect on antimicrobial resistance?  Chest 2001;119 ((2)(suppl)) 426S- 430SPubMedGoogle ScholarCrossref
30.
Kernodle  DSBarg  NLKaiser  AB Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis.  Antimicrob Agents Chemother 1988;32202- 208PubMedGoogle ScholarCrossref
31.
Harbarth  SSamore  HMLicgtenberg  DCarmeli  Y Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance.  Circulation 2000;1012916- 2921PubMedGoogle ScholarCrossref
32.
Kreisel  DSavel  TGSilver  ALCunningham  JD Surgical antibiotic prophylaxis and Clostridium difficile toxin positivity.  Arch Surg 1995;130989- 993PubMedGoogle ScholarCrossref
33.
Bantar  CSartori  BVesco  EHeft  CSaul  MSalamone  FOliva  ME A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance.  Clin Infect Dis 2003;37180- 186Epub July9 2003;PubMedGoogle ScholarCrossref
34.
Saizy-Callaert  SCausse  RFurhman  CLe Paih  MFThebault  AChouaid  C Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital.  J Hosp Infect 2003;53177- 182PubMedGoogle ScholarCrossref
35.
Brusaferro  SRinaldi  OPea  FFaruzzo  ABarbone  F Protocol implementation in hospital infection control practice: an Italian experience of preoperative antibiotic prophylaxis.  J Hosp Infect 2001;47288- 293PubMedGoogle ScholarCrossref
36.
Kim  BN Compliance with an infectious disease specialist's advisory consultations on targeted antibiotic usage.  J Infect Chemother 2005;1184- 88PubMedGoogle ScholarCrossref
37.
Holtz  THWenzel  RP Postdischarge surveillance for nosocomial wound infection: a brief review and commentary.  Am J Infect Control 1992;20206- 213PubMedGoogle ScholarCrossref
38.
Sands  KVineyard  GPlatt  R Surgical site infections occurring after hospital discharge.  J Infect Dis 1996;173963- 970PubMedGoogle ScholarCrossref
39.
Everitt  DESoumerai  SBAvorn  JKlapholz  HWessels  M Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders.  Infect Control Hosp Epidemiol 1990;11578- 583PubMedGoogle ScholarCrossref
Original Article
November 1, 2006

Implementing 1-Dose Antibiotic Prophylaxis for Prevention of Surgical Site Infection

Author Affiliations

Author Affiliations: Infection Control Department, Hospital S[[atilde]]o Francisco, Ribeir[[atilde]]o Preto, S[[atilde]]o Paulo, Brazil (Drs Fonseca, Nascimento, and de Andrade and Mss Kunzle and Junqueira); and Department of Infectious Diseases and Infection Control Department, Hospital das Clinicas, University of S[[atilde]]o Paulo (Dr Levin).

Arch Surg. 2006;141(11):1109-1113. doi:10.1001/archsurg.141.11.1109
Abstract

Hypothesis  Replacing a 24-hour regimen with a 1-dose antibiotic prophylaxis for elective surgery would not increase rates of surgical site infection and would decrease costs.

Design and Setting  Before-after trial in a tertiary, private general hospital in Ribeirão Preto, São Paulo, Brazil.

Patients  Surgery was performed on 6140 consecutive patients from February 2002 through October 2002 (period 1) and 6159 consecutive patients from December 2002 through August 2003 (period 2). Studied surgeries included orthopedic, gastrointestinal, urology, vascular, lung, head and neck, heart, gynecologic, oncology, colon, neurologic, and pediatric surgeries. The study excluded patients with infection at the time of surgery.

Intervention  Decreasing the 24-hour prophylactic antibiotic regimen to 1-dose antibiotic prophylaxis.

Main Outcome Measures  Surgical site infections in both periods measured by in-hospital surveillance and postdischarge surveillance; compliance with 1-dose prophylaxis; and costs with cephazolin.

Results  We followed up 12 299 patients during their hospital stay; postdischarge surveillance increased significantly from 2717 patients (44%) to 3066 patients (50%, P<.001). One-dose prophylaxis was correctly followed in 6123 patients (99% compliance).The rate of surgical site infection did not change in either period (2% and 2.1% respectively, P = .67). The number of cephazolin vials purchased monthly decreased from 1259 to 467 with a corresponding monthly savings of $1980.

Conclusions  One-dose antibiotic prophylaxis did not lead to an increase in rates of surgical site infection and brought a monthly savings of $1980 considering cephazolin alone. High compliance to 1-dose prophylaxis was achieved through an educational intervention encouraged by the hospital director and administrative measures that reduced access to extra doses.

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