Prolonged Antibiotic Duration Is Not Associated With Reduced Surgical Site Infection After Lower Extremity Bypass...

Area of Science:

• Vascular Surgery
• Infectious Disease Prevention
• Antimicrobial Stewardship

Background:

• Surgical site infection (SSI) is a common complication after infrainguinal bypass surgery.
• Current guidelines recommend antibiotic prophylaxis for less than 24 hours.
• Evidence on prolonged antibiotic duration efficacy in lower extremity bypass (LEB) is limited.

Purpose of the Study:

• To evaluate the association between prolonged antibiotic prophylaxis duration and postoperative SSI rates.
• To inform clinical practice regarding optimal antibiotic duration after LEB surgery.

Main Methods:

• Retrospective national cohort study using the Vascular Quality Initiative (VQI) database (2014-2023).
• Included infrainguinal bypass operations with complete antibiotic data.
• Defined standard antibiotic duration as ≤24 hours and prolonged as >24 hours.

Main Results:

• Over 21,000 procedures, 2.1% developed SSI.
• Prolonged antibiotic duration (6.6% of cases) was associated with increased SSI risk (aOR 2.01).
• Diabetes, ESRD, and longitudinal incisions were also SSI risk factors; chlorhexidine use was protective.

Conclusions:

• Prolonged perioperative antibiotic prophylaxis does not reduce SSI after infrainguinal bypass.
• Findings support limiting antibiotic duration to within 24 hours for antimicrobial stewardship.
• Optimizing antibiotic use is crucial for preventing SSIs in vascular surgery.