Key result
Among patients receiving therapeutic antibiotics for active infections prior to surgery, 44.3% were prescribed duplicative prophylactic antibiotics, which did not significantly reduce surgical site infections.
Why the study?
In patients already receiving antibiotics for active infections prior to surgery, the risks and benefits of administering perioperative prophylactic antibiotics are unknown.
Does duplicative antibiotic therapy reduce surgical site infections or increase adverse events in adult patients undergoing inpatient surgery who are already receiving antibiotic treatment for active infections?
Cohort (n=158)
No
Does duplicative antibiotic therapy reduce surgical site infections or increase adverse events in adult patients undergoing inpatient surgery who are already receiving antibiotic treatment for active infections?
Administering additional perioperative prophylactic antibiotics to patients already receiving therapeutic antibiotics does not significantly decrease surgical site infections but may increase the risk of adverse reactions such as acute kidney injury.
Caution against routine duplicative prophylaxis in infected surgical patients; cohort data leaves open need for randomized confirmation.
Objective Antimicrobial prophylaxis is administered perioperatively to prevent surgical site infections. However, in patients who have already received antibiotics for the treatment of active infections prior to surgery, the risks and benefits of administering prophylactic antibiotics are unknown. We aimed to assess the necessity of perioperative prophylactic antibiotic administration in patients receiving antibiotic treatment for active infections. Method This was a retrospective, chart-review cohort study. Between January 2018 to May 2018, adult patients who underwent inpatient surgery at the University of Illinois Hospital and Health Sciences System, and were prescribed prophylactic antibiotics based on institutional protocol, while receiving antibiotic treatment within 48 hours prior to surgery, were included in the study. The primary endpoint was the rate of duplicative antibiotic therapy, which was defined as the administered prophylactic antibiotic (1) exhibiting similar or narrower bacterial coverage as the treatment antibiotic(s), and (2) given within the dose interval of the treatment antibiotic(s). Results A total of 158 patients were included in the study, of which 70 (44.3%) received duplicative antibiotic therapy, whereas 88 (55.7%) did not. Differences in the incidence of acute kidney injury, C. difficile infection, and surgery site infections were not statistically significant between the two groups. Conclusion We found that it was common for patients receiving therapeutic systematic antibiotics to perioperatively be prescribed additional prophylactic antibiotics at our institution. However, additional prophylactic antibiotics can be unnecessary in decreasing the incidence of surgical site infections but may increase the risk of adverse reaction.
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Yin et al. (2021) conducted a cohort in Active infection requiring antibiotic treatment prior to inpatient surgery (n=158). Duplicative antibiotic therapy (DAT) vs. No duplicative antibiotic therapy was evaluated on Rate of duplicative antibiotic therapy (DAT). Among patients receiving therapeutic antibiotics for active infections prior to surgery, 44.3% were prescribed duplicative prophylactic antibiotics, which did not significantly reduce surgical site infections.
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