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Deep surgical site infections following double-dose perioperative antibiotic prophylaxis in adult obese orthopedic patients

Anita Hasler, Ines Unterfrauner, Maurits G L Olthof, Peter Jans, Michael Betz, Yvonne Achermann & Ilker Uckay

abstract

BACKGROUND
Obesity is a risk factor for surgical site infections (SSI). Based on retrospective comparisons and pharmacology, many orthopedic centers have adopted weight- or body mass index (BMI)-related antibiotic prophylaxis.

METHODS
Double-dose prophylaxis was introduced in March 2017 for patients weighting >80 kg. The period April 2014 to March 2017 ('before') was compared to the period March 2017 to June 2019 ('after') regarding the impact on deep SSIs.

RESULTS
A total of 9318 surgeries 'before' were compared to 7455 interventions 'after' the introduction of double-dose prophylaxis. Baseline demographic characteristics (age, sex, BMI, American Society of Anesthesiologists score, and duration of surgery) were similar. In the period 'after', 3088 cases (3088/16 773; 18%) received double-dose prophylaxis. Overall, 82 deep SSIs were observed (0.5%). The pathogens were resistant to the standard cefuroxime prophylaxis in 30 cases (30/82; 37%). Excluding these prophylaxis-resistant cases and all of the five hematogenous SSIs, the remaining 47 SSIs (57%) could have been prevented by the preceding prophylaxis. Double-dosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients did not reduce deep SSIs (hazard ratio 0.7, 95% confidence interval 0.3-1.6). In the direct group comparison among obese patients >80 kg, the double-dose prophylaxis equally failed to alter the SSI risk (3088/16 726 non-infections vs 8/47 SSI despite double-dose prophylaxis; Chi-square test, P = 0.78).

CONCLUSIONS
In this single-center before-and-after study with almost 17 000 orthopedic surgeries in adult patients, systemic doubling of the perioperative antibiotic prophylaxis in obese patients clinically failed to reduce the overall deep SSI risk.
   
citation Hasler A, Unterfrauner I, Olthof M G L, Jans P, Betz M, Achermann Y, Uckay I. Deep surgical site infections following double-dose perioperative antibiotic prophylaxis in adult obese orthopedic patients. Int J Infect Dis 2021; 108:537-542.
   
type journal paper/review (English)
date of publishing 10-06-2021
journal title Int J Infect Dis (108)
ISSN electronic 1878-3511
pages 537-542
PubMed 34119675
DOI 10.1016/j.ijid.2021.06.008