Dual antibiotic prevention bundle is associated with decreased surgical site infections.
gynecologic surgical procedures
gynecology
laparotomy
postoperative complications
surgical wound infection
Journal
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
ISSN: 1525-1438
Titre abrégé: Int J Gynecol Cancer
Pays: England
ID NLM: 9111626
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
24
04
2020
revised:
06
07
2020
accepted:
08
07
2020
pubmed:
31
7
2020
medline:
2
10
2021
entrez:
31
7
2020
Statut:
ppublish
Résumé
Gynecologic oncology surgery is associated with a wide variation in surgical site infection risk. The optimal method for infection prevention in this heterogeneous population remains uncertain. A retrospective cohort study was performed to compare surgical site infection rates for patients undergoing hysterectomy over a 1-year period surrounding the implementation of an institutional infection prevention bundle. The bundle comprised pre-operative, intra-operative, and post-operative interventions including a dual-agent antibiotic surgical prophylaxis with cefazolin and metronidazole. Cohorts consisted of patients undergoing surgery during the 6 months prior to this intervention (pre-bundle) versus those undergoing surgery during the 6 months following the intervention (post-bundle). Secondary outcomes included length of stay, readmission rates, compliance measures, and infection microbiology. Data were compared with pre-specified one-sided exact test, Chi-square test, Fisher's exact test, or Kruskal-Wallis test as appropriate. A total of 358 patients were included (178 PRE, 180 POST). Median age was 58 (range 23-90) years. The post-bundle cohort had a 58% reduction in surgical site infection rate, 3.3% POST vs 7.9% PRE (-4.5%, 95% CI -9.3% to -0.2%, p=0.049) as well as reductions in organ space infection, 0.6% POST vs 4.5% PRE (-3.9%, 95% CI -7.2% to -0.7%, p=0.019), and readmission rates, 2.2% POST vs 6.7% PRE (-4.5%, 95% CI -8.7% to -0.2%, p=0.04). Gram-positive, Gram-negative, and anaerobic bacteria were all prevalent in surgical site infection cultures. There were no monomicrobial infections in post-cohort cultures (0% POST vs 58% PRE, p=0.04). No infections contained methicillin-resistant Implementation of a dual antibiotic infection prevention bundle was associated with a 58% reduction in surgical site infection rate after hysterectomy in a surgically diverse gynecologic oncology practice.
Sections du résumé
BACKGROUND
Gynecologic oncology surgery is associated with a wide variation in surgical site infection risk. The optimal method for infection prevention in this heterogeneous population remains uncertain.
STUDY DESIGN
A retrospective cohort study was performed to compare surgical site infection rates for patients undergoing hysterectomy over a 1-year period surrounding the implementation of an institutional infection prevention bundle. The bundle comprised pre-operative, intra-operative, and post-operative interventions including a dual-agent antibiotic surgical prophylaxis with cefazolin and metronidazole. Cohorts consisted of patients undergoing surgery during the 6 months prior to this intervention (pre-bundle) versus those undergoing surgery during the 6 months following the intervention (post-bundle). Secondary outcomes included length of stay, readmission rates, compliance measures, and infection microbiology. Data were compared with pre-specified one-sided exact test, Chi-square test, Fisher's exact test, or Kruskal-Wallis test as appropriate.
RESULTS
A total of 358 patients were included (178 PRE, 180 POST). Median age was 58 (range 23-90) years. The post-bundle cohort had a 58% reduction in surgical site infection rate, 3.3% POST vs 7.9% PRE (-4.5%, 95% CI -9.3% to -0.2%, p=0.049) as well as reductions in organ space infection, 0.6% POST vs 4.5% PRE (-3.9%, 95% CI -7.2% to -0.7%, p=0.019), and readmission rates, 2.2% POST vs 6.7% PRE (-4.5%, 95% CI -8.7% to -0.2%, p=0.04). Gram-positive, Gram-negative, and anaerobic bacteria were all prevalent in surgical site infection cultures. There were no monomicrobial infections in post-cohort cultures (0% POST vs 58% PRE, p=0.04). No infections contained methicillin-resistant
CONCLUSION
Implementation of a dual antibiotic infection prevention bundle was associated with a 58% reduction in surgical site infection rate after hysterectomy in a surgically diverse gynecologic oncology practice.
Identifiants
pubmed: 32727930
pii: ijgc-2020-001515
doi: 10.1136/ijgc-2020-001515
pmc: PMC7868167
mid: NIHMS1666055
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1411-1417Subventions
Organisme : NCI NIH HHS
ID : P30 CA076292
Pays : United States
Informations de copyright
© IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Gynecol Oncol. 2013 Jul;130(1):100-6
pubmed: 23558053
Am J Med. 1991 Sep 16;91(3B):152S-157S
pubmed: 1656747
AORN J. 2014 Feb;99(2):315-9
pubmed: 24472594
Gynecol Oncol. 2020 Feb;156(2):284-287
pubmed: 31776038
Am J Obstet Gynecol. 2020 Mar;222(3):219-223
pubmed: 31499057
Gynecol Oncol. 2019 Mar;152(3):480-485
pubmed: 30876492
Rev Urol. 2009 Fall;11(4):190-5
pubmed: 20111631
Gynecol Oncol. 2017 Oct;147(1):115-119
pubmed: 28734498
Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S51-61
pubmed: 18840089
BMJ Open. 2019 Jan 24;9(1):e024853
pubmed: 30679297
Asian Spine J. 2015 Jun;9(3):423-6
pubmed: 26097658
Obstet Gynecol. 2018 Jun;131(6):991-999
pubmed: 29742666
Am J Obstet Gynecol. 2005 Feb;192(2):422-5
pubmed: 15695981
Am J Surg. 2014 Nov;208(5):835-840
pubmed: 25113797
Obstet Gynecol. 2013 Sep;122(3):718-20
pubmed: 23963423
J Am Coll Surg. 2013 Jan;216(1):23-33
pubmed: 23127793
Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283
pubmed: 23327981
J Am Coll Surg. 2017 Jan;224(1):59-74
pubmed: 27915053
J Gastrointest Surg. 2017 Nov;21(11):1915-1930
pubmed: 28620749
Obstet Gynecol. 2016 Jun;127(6):1135-1144
pubmed: 27159744
Obstet Gynecol. 2017 Oct;130(4):756-764
pubmed: 28885412
J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):901-9
pubmed: 24768957
Surg Infect (Larchmt). 2017 May/Jun;18(4):379-382
pubmed: 28541808
Infect Dis Obstet Gynecol. 2002;10(3):133-40
pubmed: 12625969
Int J Gynecol Cancer. 2014 May;24(4):779-86
pubmed: 24681712