Comparative Effectiveness of Vancomycin Versus Vancomycin Plus β-Lactams for Prevention of Surgical Site Infections
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. The optimal regimen for pre-operative antibiotic prophylaxis is controversial. Prior studies suggest that beta-lactam antibiotics (BLA) are superior to vancomycin (vanco) for preventing surgical site infections (SSI), however, whether there is an additional benefit to adding a BLA to vanco remains unknown. Thus, we sought to evaluate the comparative effectiveness of vanco versus vanco plus BLA for SSI prevention. Methods. All patients who underwent surgery within the national VA healthcare system during the period from October 1, 2008 to September 30, 2013, received vanco, and had SSI outcomes and prophylaxis manually validated were included. Primary outcome was incidence of SSI among patients receiving vanco versus vanco plus BLA. Secondary analysis evaluated SSI incidence stratified by types of surgical procedures. Known confounders were included in the multivariable logistic regression (table). Results. 20,056 unique procedures were included. 33.6% (6603 of 20,056) received vanco only and 66.4% (13,324 of 20,056) received vanco plus BL. Among patients receiving vanco only, the SSI incidence was 1.9% (129 of 6732) versus 1.3% (177 of 13,324) among patients receiving vanco plus BLA, a 31.6% reduction, P < .0001. Among cardiac procedures, the incidence of SSI was 0.80% (25 of 3,137) in the vanco group versus 0.42% (31 of 7337) in the vanco plus BLA group, a 47.5% reduction, P = .00014. There was no difference in SSI outcome among other types of surgical procedures, including total joint replacements. Adjusted results are presented in table. Adjusted Model for SSI Risk in Patients Receiving Vancomycin Versus Vancomycin Plus a β-Lactam Antibiotic Conclusion. Adding a BLA to vanco for peri-operative SSI prevention significantly reduces the incidence of SSI, independent of ASA class and MRSA-colonization status; the association is strongest for cardiac surgical procedures. Further analysis of effect modifiers and confounders, including other MRSA-targeted prevention strategies, need to be investigated. Disclosures. K. Itani, Sanofi: Investigator, Grant recipient
Source: Open Forum Infectious Diseases
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2338921178