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Original research
Dual antibiotic prevention bundle is associated with decreased surgical site infections
  1. Michelle Kuznicki1,
  2. Adrianne Mallen2,3,
  3. Emily Clair McClung4,
  4. Sharon E Robertson5,6,
  5. Sarah Todd7,
  6. David Boulware8,
  7. Stacy Martin8,
  8. Rod Quilitz9,
  9. Roberto J Vargas1 and
  10. Sachin M Apte3
  1. 1 Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2 Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
  3. 3 Gynecologic Oncology, H Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
  4. 4 Gynecologic Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA
  5. 5 Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  6. 6 Gynecologic Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
  7. 7 Gynecologic Oncology, University of Louisville, Louisville, Kentucky, USA
  8. 8 Infection Prevention, H Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
  9. 9 Pharmacy, H Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, United States
  1. Correspondence to Dr Michelle Kuznicki, Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; kuznicm{at}ccf.org

Abstract

Background Gynecologic oncology surgery is associated with a wide variation in surgical site infection risk. The optimal method for infection prevention in this heterogeneous population remains uncertain.

Study Design A retrospective cohort study was performed to compare surgical site infection rates for patients undergoing hysterectomy over a 1-year period surrounding the implementation of an institutional infection prevention bundle. The bundle comprised pre-operative, intra-operative, and post-operative interventions including a dual-agent antibiotic surgical prophylaxis with cefazolin and metronidazole. Cohorts consisted of patients undergoing surgery during the 6 months prior to this intervention (pre-bundle) versus those undergoing surgery during the 6 months following the intervention (post-bundle). Secondary outcomes included length of stay, readmission rates, compliance measures, and infection microbiology. Data were compared with pre-specified one-sided exact test, Chi-square test, Fisher’s exact test, or Kruskal–Wallis test as appropriate.

Results A total of 358 patients were included (178 PRE, 180 POST). Median age was 58 (range 23–90) years. The post-bundle cohort had a 58% reduction in surgical site infection rate, 3.3% POST vs 7.9% PRE (−4.5%, 95% CI −9.3% to −0.2%, p=0.049) as well as reductions in organ space infection, 0.6% POST vs 4.5% PRE (−3.9%, 95% CI −7.2% to −0.7%, p=0.019), and readmission rates, 2.2% POST vs 6.7% PRE (−4.5%, 95% CI −8.7% to −0.2%, p=0.04). Gram-positive, Gram-negative, and anaerobic bacteria were all prevalent in surgical site infection cultures. There were no monomicrobial infections in post-cohort cultures (0% POST vs 58% PRE, p=0.04). No infections contained methicillin-resistant Staphylococcus aureus.

Conclusion Implementation of a dual antibiotic infection prevention bundle was associated with a 58% reduction in surgical site infection rate after hysterectomy in a surgically diverse gynecologic oncology practice.

  • surgical wound infection
  • gynecologic surgical procedures
  • gynecology
  • postoperative complications
  • laparotomy

https://doi.org/10.1136/ijgc-2020-001515

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    Footnotes

    • Twitter @m_kuznicki

    • Presented at Data reported in this article were previously presented at the Society of Gynecologic Oncology 49th Annual Meeting on Women’s Cancer held in New Orleans, LA, USA on March 24–27, 2018.

    • Contributors MK: conceptualization; data curation; methodology; project administration; original draft, review, and editing. AM: data curation; methodology; project administration; original draft, review, and editing. ECMC: data curation; methodology; curation; project administration; review and editing. SER: methodology; project administration; review and editing. ST: methodology; project administration; review and editing. DB: formal analysis; original draft, review, and editing. SM: methodology, project administration; review and editing. RQ: methodology, project administration; review and editing. RJV: project administration; review and editing. SMA: conceptualization; methodology; project administration; review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Deidentified clinical data are available upon request from the corresponding author at kuznicm@ccf.org. There is no additional information available other than that referenced in the article.