Moving Closer to Zero: Effect of "Just in Time" Dosing of Prophylactic Antibiotics on Surgical Site Infections.

BACKGROUND

A local quality initiative to improve compliance with surgical antibiotic prophylaxis measures resulted in a high percentage of patients receiving antibiotics within minutes of surgical incision. Studies examining the association between timing of prophylaxis and the risk for surgical site infection (SSI) have produced heterogeneous results.

OBJECTIVE

To examine risk factors for SSI, including "just in time" dosing of antibiotic prophylaxis (dose administered within 5 minutes of incision).

METHODS

This was a retrospective matched case-control study. Case patients developed SSI in the 30 days following a clean or clean-contaminated surgical procedure. Control patients did not develop SSI following similar procedures and were matched to ensure comparable baseline risk. We assessed the rate of guideline-compliant antibiotic prophylaxis and calculated odds ratios (ORs) to determine the association of patient covariates with the risk for SSI.

RESULTS

Forty case patients and 104 controls were included in the study. The rate of appropriate prophylaxis was high in both groups (98% and 94% for case and control groups, respectively). Approximately 15% of case and control patients received antibiotic prophylaxis within 5 minutes of incision, thus, "just in time" dosing did not appear to increase the risk for SSI (OR, 0.814; 95% CI, 0.274-2.415). There was a nonsignificant association between receipt of vancomycin and SSI (OR, 2.844; 95% CI, 0.926-8.737).

CONCLUSION

"Just in time" dosing of prophylactic antibiotics was not associated with increased risk for SSI. Further study is needed to clarify the impact of antibiotic choice on the risk for subsequent SSI.