A newly published article in The Lancet Infectious Diseases found that an earlier surgical microbial prophylaxis administration time did not significantly decrease the risk of surgical site infections when compared to a later SAP administration time.
Research has identified surgical site infections (SSIs) as one of the most expensive and prevalent hospital-acquired infections amongst surgical patients. Multiple studies have deduced that surgical antimicrobial prophylaxis (SAP) is an incredibly effective treatment method for SSIs following an array of surgical operations. Cephalosporins (class of antibacterial drugs used to treat bacterial infections) are used routinely as SAP, and they are often used in conjunction with metronidazole (another antibiotic used to treat a variety of bacterial infections including skin and respiratory infections. In their 2016 guidelines, the World Health Organization states that SAP should be administered less than 120 minutes prior to the surgical incision in order to prevent SSIs.; however, the WHO guidelines recommend a SAP administration time of less than 60 minutes before the incision for antibiotics with short half-lives (the time period it takes to reduce the amount of a drug in the body). The 2016 WHO guidelines concluded that a randomized controlled trial (RCT) is warranted to determine the ideal timing for SAP administration after surgical operations. To address this research gap, Swiss researchers designed a RCT, published in The Lancet Infectious Diseases, to test the hypothesis that an earlier SAP administration time of the drug cefuroxime (an antibiotic used to treat and prevent surgical infections) would be superior to a later SAP administration time prior to surgical incisions for the prevention of SSIs.
5580 surgical patients were included in the study and were randomly assigned to receive SAP earlier in the anesthesia room (2798 patients) or later in the operating room (2782 patients), prior to incision. The median SAP administration time for the patients assigned to the earlier group was 42 minutes, whereas the median time for the later SAP administration group was 16 minutes. The occurrence rate of SSIs was found to be approximately 5.1% (234/4596 patients). These patients were followed for 30 days after surgery. Moreover, 5.3% (121 patients) of SSIs occurred within the late SAP administration group, while 4.9% (113 patients) of SSIs occurred in the earlier SAP administration group of patients.
In the end, researchers concluded that earlier SAP administration of cefuroxime (in addition to metronidazole during colorectal surgery) did not significantly decrease the risk of SSI in comparison to the later SAP administration time before any surgical incisions. These results do not provide strong enough evidence to alter current recommendations involving the administration of SAP during 60 minutes before any surgical incisions.
Written By: Melissa Booker