Skip to main content
×
Home
    • Aa
    • Aa

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

  • Sandra I. Berríos-Torres (a1), Sarah H. Yi (a1), Dale W. Bratzler (a2), Allen Ma (a3), Yi Mu (a1), Liping Zhu (a1) and John A. Jernigan (a1)...
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.

Copyright
Corresponding author
1600 Clifton Road NE, MS A-31, Atlanta, GA 30333 (zbn6@cdc.gov)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3. CS Abboud , SB Wey , VT Baltar . Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004;77(2):676683.

4. M Sharma , MG Fakih , D Berriel-Cass , S Meisner , L Saravolatz , R Khatib . Harvest surgical site infection following coronary artery bypass grafting: risk factors, microbiology, and outcomes. Am J Infect Control 2009;37(8):653657.

5. DM Urquhart , FS Hanna , SL Brennan , et al.Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplasty 2010;25(8): 12161222.

6. SM Kurtz , KL Ong , E Lau , KJ Bozie , D Berry , J Parvizi . Prosthetic joint infection risk after TKA in the medicare population. Clin Orthop Relat Res 2010;468(1):5256.

7. I Risnes , M Abdelnoor , SM Almdahl , JL Svennevig . Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg 2010;89(5):15021509.

8. CS Hollenbeak , DM Murphy , S Koenig , RS Woodward , WC Dun-agan , VJ Fraser . The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118(2):397402.

10. SM Kurtz , E Lau , H Watson , JK Schmier , J Parvizi . Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27(suppl 8):61.el65.el.

11. M Hellmann , SD Mehta , DM Bishai , SC Mears , JM Zenilman . The estimated magnitude and direct hospital costs of prosthetic joint infections in the United States, 1997 to 2004. J Arthroplasty 2010;25(5):766771.

14. R Engelman , D Shahian , R Shemin , 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):15691576.

16. DW Bratzier , EP Dellinger , KM Olsen , et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195283.

17. DW Bratzier , DR Hunt . The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006; 43(3):322330.

25. DJ Anderson , KS Kaye , LF Chen , 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.

26. SM Kurtz , KL Ong , J Schmier , et al.Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007;89(suppl 3):144151.

28. D Chambers , G Worthy , L Myers , et al. vs Glycopeptide . nonglycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review. Surg Infect (Larchmt) 2010;11(5):455462.

29. A Sewick , A Makani , C Wu , J O'Donnell , KD Baldwin , GC Lee . Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty? Clin Orthop Relat Res 2012; 470(10):27022707.

30. T Crawford , KA Rodvold , JS Solomkin . Vancomycin for surgical prophylaxis? Clin Infect Dis 2012;54(10):14741479.

31. MK Bolon , M Morlote , SG Weber , B Koplan , Y Carmeli , SB Wright . 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):13571363.

32. DW Bratzler , PM Houck , C Richards , et al.Use of antimicrobial prophylaxis for major surgery—baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005; 140(2):174182.

34. R Finkelstein , G Rabino , T Mashiah , 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):326332.

35. R Kitzes-Cohen , D Farin , G Piva , et al.Pharmacokinetics of vancomycin administered as prophylaxis before cardiac surgery. Ther Drug Monit 2000;22(6):661667.

36. C Martin , M Alaya , MN Mallet , et al.Penetration of vancomycin into mediastinal and cardiac tissues in humans. Antimicrob Agents Chemother 1994;38(2):396399.

37. FA Manían , PL Meyer , J Setzer , D Senkel . Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis 2003;36(7):863868.

39. RO Darouiche , MJ Wall Jr, KM Itani , et al.Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):1826.

40. CA Lucero , J Hageman , ER Zell , 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):50615068.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 14 *
Loading metrics...

Abstract views

Total abstract views: 56 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 27th May 2017. This data will be updated every 24 hours.