Hostname: page-component-745bb68f8f-d8cs5 Total loading time: 0 Render date: 2025-01-09T22:02:58.677Z Has data issue: false hasContentIssue false
  • English
  • Français

Activity of Commonly Used Antimicrobial Prophylaxis Regimens against Pathogens Causing Coronary Artery Bypass Graft and Arthroplasty Surgical Site Infections in the United States, 2006–2009

Published online by Cambridge University Press:  10 May 2016

Sandra I. Berríos-Torres ,
Sarah H. Yi ,
Dale W. Bratzler ,
Allen Ma ,
Yi Mu ,
Liping Zhu  and
John A. Jernigan
Sandra I. Berríos-Torres*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah H. Yi
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Dale W. Bratzler
Affiliation:
College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Allen Ma
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
Yi Mu
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Liping Zhu
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road NE, MS A-31, Atlanta, GA 30333 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Coronary artery bypass graft (CABG) and primary arthroplasty surgical site infection (SSI) rates are declining slower than other healthcare-associated infection rates. We examined antimicrobial prophylaxis (AMP) regimens used for these operations and compared their spectrum of activity against reported SSI pathogens.

Methods.

Pathogen distributions of CABG and hip/knee arthroplasty complex SSIs (deep and organ/space) reported to the National Healthcare Safety Network (NHSN) from 2006 through 2009 and AMP regimens (same procedures and time period) reported to the Surgical Care Improvement Project (SCIP) were analyzed. Regimens were categorized as standard (cefazolin or cefuroxime), β-lactam allergy (vancomycin or clindamycin with or without an aminoglycoside), and extended spectrum (vancomycin and/or an aminoglycoside with cefazolin or cefuroxime). AMP activity of each regimen was predicted on the basis of pathogen susceptibility reports and published spectra of antimicrobial activity.

Results.

There were 6,263 CABG and arthroplasty complex SSIs reported (680,489 procedures; 880 NHSN hospitals). Among 6,574 pathogens reported, methicillin-sensitive Staphylococcus aureus (23%), methicillin-resistant S. aureus (18%), coagulase-negative staphylococci (17%), and Enterococcus species (7%) were most common. AMP regimens for 2,435,703 CABG and arthroplasty procedures from 3,330 SCIP hospitals were analyzed. The proportion of pathogens predictably susceptible to standard (used in 75% of procedures), β-lactam (12%), and extended-spectrum (8%) regimens was 41%–45%, 47%–96%, and 81%—96%, respectively.

Conclusion.

Standard AMP, used in three-quarters of CABG and primary arthroplasty procedures, has inadequate activity against more than half of SSI pathogens reported. Alternative strategies may be needed to prevent SSIs caused by pathogens resistant to standard AMP regimens.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 231 - 239
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. De Frances, CJ, Lucas, CA, Buie, VC, Golosinskiy, A. 2006 National Hospital Discharge Survey. June 30 ed. Hyattsville, MD: National Center for Health Statistics, 2008.Google Scholar
2. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project net (H-CUPnet) website. 2011 Nationwide Inpatient Sample (NIS). Published 2013. http://hcupnet.ahrq.gov/. Accessed June 27, 2013.Google Scholar
3. Abboud, CS, Wey, SB, Baltar, VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004;77(2):676–683.CrossRefGoogle ScholarPubMed
4. Sharma, M, Fakih, MG, Berriel-Cass, D, Meisner, S, Saravolatz, L, Khatib, R. Harvest surgical site infection following coronary artery bypass grafting: risk factors, microbiology, and outcomes. Am J Infect Control 2009;37(8):653–657.Google Scholar
5. Urquhart, DM, Hanna, FS, Brennan, SL, et al. Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplasty 2010;25(8): 1216–1222.CrossRefGoogle ScholarPubMed
6. Kurtz, SM, Ong, KL, Lau, E, Bozie, KJ, Berry, D, Parvizi, J. Prosthetic joint infection risk after TKA in the medicare population. Clin Orthop Relat Res 2010;468(1):52–56.Google Scholar
7. Risnes, I, Abdelnoor, M, Almdahl, SM, Svennevig, JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg 2010;89(5):1502–1509.Google Scholar
8. Hollenbeak, CS, Murphy, DM, Koenig, S, Woodward, RS, Dun-agan, WC, Fraser, VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118(2):397–402.Google Scholar
9. McGarry, SA, Engemann, JJ, Schmader, K, Sexton, DJ, Kaye, KS. Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hasp Epidemiol 2004;25(6):461–467.Google Scholar
10. Kurtz, SM, Lau, E, Watson, H, Schmier, JK, Parvizi, J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27(suppl 8):61.el–65.el.CrossRefGoogle ScholarPubMed
11. Hellmann, M, Mehta, SD, Bishai, DM, Mears, SC, Zenilman, JM. The estimated magnitude and direct hospital costs of prosthetic joint infections in the United States, 1997 to 2004. J Arthroplasty 2010;25(5):766–771.Google Scholar
12. US Department of Health and Human Services. HHS Action Plan to Prevent Healthcare Associated Infections: Appendix G. http://www.hhs.gov/ash/initiatives/hai/actionplan/. Accessed March 5, 2012.Google Scholar
13. Medical Letter. Antimicrobial prophylaxis for surgery. Treat Cuidel Med Lett. 2009;7(82):47–52.Google Scholar
14. Engelman, R, Shahian, D, Shemin, R, et al. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part II: antibiotic choice. Ann Thorac Surg 2007; 83(4):1569–1576.Google Scholar
15. American Academy of Orthopaedic Surgeons. Information Statement: Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty. Published 2004. http://www6.aaos.org/news/PDFopen/PDFopen.cfm?page_url=http://www.aaos.org/about/papers/advistmt/1027.asp. Accessed February 8, 2012.Google Scholar
16. Bratzier, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195–283.CrossRefGoogle Scholar
17. Bratzier, DW, Hunt, DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006; 43(3):322–330.CrossRefGoogle Scholar
18. Malpiedi, PJ, Peterson, KD, Soe, MM, et al. 2011 National and State Healthcare-Associated Infection Standardized Infection Ratio Report. Published 2013. http://www.cdc.gov/hai/pdfs/SIR/SIR-Report_02_07_2013.pdf. Accessed June 13, 2013.Google Scholar
19. Anderson, DJ, Arduino, JM, Reed, SD, et al. Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure. Infect Control Hosp Epidemiol 2010;31(7):701–709.Google Scholar
20. Centers for Disease Control and Prevention. National Healthcare Safety Network: Surgical Site Infection (SSI) Event. http://www.xdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Accessed February 8, 2012.Google Scholar
21. QualityNet. Specifications Manual for National Hospital Inpatient Quality Measures. Version 1.04a-3.0c. http://www.qualitynet.org/dcs/ContentServer?c = Page&pagename = QnetPublic%2FPage %2FQnetTier4&cid= 1228695698425. Accessed June 15, 2012.Google Scholar
22. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32(10):970–986.Google Scholar
23. Bratzler, DW, Houck, PM; Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38(12):1706–1715.Google Scholar
24. Mandeli, GL, Bennet, JE, Dolin, R, eds. Mandeli, Douglas, and Bennett's Principles and Practices of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone, 2005.Google Scholar
25. Anderson, DJ, Kaye, KS, Chen, LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE 2009;4(12):e8305.CrossRefGoogle ScholarPubMed
26. Kurtz, SM, Ong, KL, Schmier, J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007;89(suppl 3):144–151.Google Scholar
27. Miller, LG, McKinnell, JA, Vollmer, ME, Spellberg, B. Impact of methicillin-resistant Staphylococcus aureus prevalence among S. aureus isolates on surgical site infection risk after coronary artery bypass surgery. Infect Control Hosp Epidemiol 2011;32(4):342–350.Google Scholar
28. Chambers, D, Worthy, G, Myers, L, et al. Glycopeptide, vs. nonglycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review. Surg Infect (Larchmt) 2010;11(5):455–462.Google Scholar
29. Sewick, A, Makani, A, Wu, C, O'Donnell, J, Baldwin, KD, Lee, GC. Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty? Clin Orthop Relat Res 2012; 470(10):2702–2707.Google Scholar
30. Crawford, T, Rodvold, KA, Solomkin, JS. Vancomycin for surgical prophylaxis? Clin Infect Dis 2012;54(10):1474–1479.CrossRefGoogle ScholarPubMed
31. Bolon, MK, Morlote, M, Weber, SG, Koplan, B, Carmeli, Y, Wright, SB. Glycopeptides are no more effective than β-lactam agents for prevention of surgical site infection after cardiac surgery: a meta-analysis. Clin Infect Dis 2004;38(10):1357–1363.Google Scholar
32. Bratzler, DW, Houck, PM, Richards, C, et al. Use of antimicrobial prophylaxis for major surgery—baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005; 140(2):174–182.Google Scholar
33. Rubin, ZA, Edwards, JR, Horan, TC, Jernigan, JA. Staphylococcal surgical site infection following coronary artery bypass and joint replacement surgery: National Nosocomial Infections Surveillance System, 1994-2003. In: Program and Abstracts of the Society for Healthcare Epidemiology of America's 15th Annual Scientific Meeting. Arlington, VA: Society for Healthcare Epidemiology of America, 2005. Abstract 42.Google Scholar
34. Finkelstein, R, Rabino, G, Mashiah, T, et al. Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections. J Thorac Cardiovasc Surg 2002;123(2):326–332.Google Scholar
35. Kitzes-Cohen, R, Farin, D, Piva, G, et al. Pharmacokinetics of vancomycin administered as prophylaxis before cardiac surgery. Ther Drug Monit 2000;22(6):661–667.CrossRefGoogle ScholarPubMed
36. Martin, C, Alaya, M, Mallet, MN, et al. Penetration of vancomycin into mediastinal and cardiac tissues in humans. Antimicrob Agents Chemother 1994;38(2):396–399.Google Scholar
37. Manían, FA, Meyer, PL, Setzer, J, Senkel, D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis 2003;36(7):863–868.Google Scholar
38. Diekema, D, Johannsson, B, Herwaldt, L, et al. Current practice in Staphylococcus aureus screening and decolonization. Infect Control Hosp Epidemiol 2011;32(10):1042–1044.Google Scholar
39. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18–26.Google Scholar
40. Lucero, CA, Hageman, J, Zell, ER, et al. Evaluating the potential public health impact of a Staphylococcus aureus vaccine through use of population-based surveillance for invasive methicillin-resistant S. aureus disease in the United States. Vaccine 2009; 27(37):5061–5068.CrossRefGoogle ScholarPubMed