Non-compliance with guidelines for surgical antibiotic prophylaxis and the risk of surgical site infection: results from the INCISO Surveillance Network

Abstract number: P745

Miliani K.Y., L'Hériteau F., Astagneau P.

Objectives: Antibiotic prophylaxis reduces the incidence of surgical site infection (SSI) for many procedures. Nonetheless, these medications are not always given appropriately. The aim of this study was to describe practices of surgical antibiotic prophylaxis (SAP) and to determine whether the risk of SSI vary according to these practices.

Methods: Data were collected during a 7-year surveillance period (2001 to 2007) from the INCISO surveillance network based on volunteer participation of surgery wards in Northern France. Major aspects of SAP were evaluated including antibiotic agent choice, timing administration of first dose, total SAP duration and compliance to standard guidelines. The study focused on a few standard procedures in digestive, orthopaedic, gynaecological and cardiovascular surgery, for which a SAP is usually recommended. Univariate and multivariate logistic regression analyses were carried out to identify SAP-, patient-, and procedure-specific factors associated with SSI.

Results: Of 8029 surgical procedures which were assessed for compliance to guidelines, 7330 (91.3%) received SAP and 184 (2.6%) developed SSIs. Among patients receiving SAP, 83.3% received appropriate antibiotic agent and 82.6% had an optimal timing of administration. SAP was considered to be appropriate in 35.0%, unnecessarily prolonged in 45.2%, and shorter than recommended in 19.8% (e.g. when a single dose was administered instead of several for a longer surgical procedure). After adjustment for surgical speciality, NNIS risk index, age, and pre-operative hospital stay in the multivariate analysis, the risk of SSI increased significantly if SAP was shorter than recommended (OR = 1.8, 95% Confidence Interval: 1.2–2.8). Non significant relationships were observed between SSI and the other SAP parameters.

Conclusions: Inappropriate SAP duration was the most significant non-compliant practice associated with an increased SSI risk after some standard procedures. Information towards practitioners should be reinforced based on standard guidelines.