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J Am Coll Surg. 2019 Nov;229(5):487-496.e2. doi: 10.1016/j.jamcollsurg.2019.07.011. Epub 2019 Aug 1.

β-Lactam vs Non-β-Lactam Antibiotics and Surgical Site Infection in Colectomy Patients.

Author information

1
Michigan Surgical Quality Collaborative, Ann Arbor, MI; Department of Chemistry, University of Michigan, Ann Arbor, MI.
2
Michigan Surgical Quality Collaborative, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.
3
Department of Surgery, University of Michigan, Ann Arbor, MI.
4
Department of Pharmacy, University of Michigan, Ann Arbor, MI.
5
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
6
Department of Allergy and Immunology, University of Michigan, Ann Arbor, MI.
7
Michigan Surgical Quality Collaborative, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: krapohlg@med.umich.edu.

Abstract

BACKGROUND:

Surgical site infections (SSIs) represent a significant preventable source of morbidity, mortality, and cost. Prophylactic antibiotics have been shown to decrease SSI rates, and β-lactam antibiotics are recommended by national guidelines. It is currently unclear whether recommended β-lactam and recommended non-β-lactam antibiotic regimens are equivalent with respect to SSI risk reduction in colectomy patients.

STUDY DESIGN:

We conducted a retrospective cohort study of SSI rates between prophylactic intravenously administered recommended β-lactam and non-β-lactam in colectomy patients (25 CPT codes) collected by the Michigan Surgical Quality Collaborative from January 2013 to February 2018. Surgical site infection rates were compared as a dichotomous variable (no SSI vs SSI). Mixed-effects regression was used to compare the association between receiving a β-lactam or non-β-lactam antibiotic and likelihood of having an SSI.

RESULTS:

Of 9,949 patients, 9,411 (94.6%) received β-lactam antibiotics and 538 (5.4%) received non-β-lactam antibiotics. Overall, there were 622 (6.3%) patients with SSIs. Of the patients receiving β-lactam antibiotics, SSIs developed in 571 (6.1%) compared with 51 (9.5%) patients in the non-β-lactam group. After applying mixed-effects logistic regression, prophylactic treatment with a non-β-lactam regimen was associated with significantly higher odds of surgical site infection (odds ratio 1.65; 95% CI 1.20 to 2.26; p < 0.01).

CONCLUSIONS:

Colectomy patients receiving β-lactam antibiotics had a lower likelihood of SSI compared with those receiving non-β-lactam antibiotics, even when antibiotics were compliant with national recommendations. Our findings suggest that surgeons should prescribe β-lactam antibiotics for prophylaxis whenever possible, reserving alternatives for those rare patients with true allergies or clinical indications for non-β-lactam antibiotic prophylaxis.

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