Antibiotic prophylaxis for surgical-site infections and adherence to evidence-based guidelines

Antimicrobial prophylaxis is an established practice for reducing surgical-site infections; however, its misuse promotes alternative challenges including antimicrobial resistance. The objective of this study was to determine factors associated with adherence to surgical antibiotic prophylaxis guidelines.

Adults aged 18 and older who underwent 1 of 5 selected procedures between 2004 and 2022 were included. The proportion of appropriate antibiotic prophylaxis was determined for each procedure type. A logistic regression model was built to identify factors impacting appropriate prophylaxis practices.

Among our cohort of 9,543 patients, 4,883 were women (51.2%); mean age was 60.1 years. Most patients were White (8,407; 88.1%). Cardiothoracic, neurosurgical, gastrointestinal, and plastic surgery procedures were individually associated with decreased odds of appropriate antibiotic prophylaxis use compared with orthopedic procedures (P < .05). Patients undergoing a cardiothoracic procedure were less likely to receive the correct antibiotic (59.0%). Patients undergoing a gastrointestinal procedure were less likely to receive prophylaxis with the appropriate start time (72.6%) or duration (5.4%). Appropriate antibiotic prophylaxis was more likely in patients who were male (odds ratio, 1.14; 95% confidence interval, 1.10-1.18) and White (odds ratio, 1.17; 95% confidence interval, 1.11-1.22). Appropriate prophylaxis was significantly greater in procedures after 2010 (representing the establishment of an antimicrobial stewardship program) compared with procedures before 2010 (odds ratio, 2.05; confidence interval, 1.95-2.16).

Appropriate antibiotic prophylaxis practices demonstrated significant variation according to specialty type, patient characteristics, and the implementation of an antimicrobial stewardship program. These findings suggest the beneficial role of stewardship programs and gaps where interventions can be targeted, particularly antibiotic selection and discontinuation timing.