Susceptibility of perioperatively isolated bacteria to cefazolin – A pilot study
Abstract
Introduction: The selection of perioperative prophylactic antibiotic is based on the expected bacterial flora in the site of the surgical procedure and its susceptibility to antibiotics. Recent reports on coagulase-negative staphylococci, typical representatives of skin flora, showed their resistance to methicillin. We may wonder whether cefazolin is still the antibiotic of choice for surgical prophylaxis in clean surgical procedures.
Patients and methods: In a prospective study we included patients who underwent surgical treatment for various types of injuries. Three swab samples were taken in each patient.
The first sample was taken from the incision site before the operating field was prepared. The second swab was taken after the operating field preparation and the third was taken at the end of the operation. The results of microbial growth and the susceptibility to antibiotics were recorded. The incidence of a wound infection in patients included in the study was followed prospectively. In the case of infection, the bacteria isolated intraoperatively during the surgical revision were compared to the bacteria isolated perioperatively at the time of the first surgery. All patients received cefazolin in a single dose of 1 to 2 grams according to their weight pre-operatively. The antibiotic was administered 20 minutes before the incision. No additional antibiotic dose was given after surgery.
Results: Before the operating field was prepared, swabs were sterile in two patients (6.4 %), at the end of preparation the swabs remained sterile in 22 (71 %) patients and at the end of surgery in 13 (42 %) out of the 31 injured patients. There were no methicillin-resistant swab cultures after operative field preparation, but at the end of surgery in four patients (13 %) the swab cultures grew methicillin resistant Staphylococcus epidemidis. Bacillus sp. was isolated in five patients (16.1 %) after operative field preparation and in two patients (6.4 %) at the end of surgery. The susceptibility of the Bacillus sp. was not determined because of the lack of standardized testing method.
Conclusion: In a pilot study we found a large proportion (4/31) of patients in whom colonization of the operative field with cefazolin-resistant bacteria developed during the surgical procedure. The result of our pilot study challenges the guidelines recommending cefazolin for surgical prophylaxis in clean surgery. Further studies in larger patient population are needed.
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References
Fletcher N, Sofianos D, Barkes MD, Obremskey WT. Prevention of Perioperative Infection. Current Concept Review. J Bone Joint Surg AM 2007; 89: 1605–18.
National Nosocomial Infections Surveillance System. Nationa Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470–85.
Kirkland KB, Briggs JPO, Trivette SL, et al. The impact of surgical site infections in the 1990s. Infect Control Hosp Epidemiol 1999; 20: 725–30.
Hollenbeak CS, Murphy DM, Koenig S, et al. The clinical AMD economic impact of deep chest surgical site infections following artery bypass graft surgery. Chest 2000; 118: 397–402.
Vonberg RP, Gastmeier P. Prevention of Surgical Site Infections in Bone AMD Joint Procedures. Curr Infect Dis Rep 2012; 14: 576–584.
Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittman DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for critical care. Arch Surg 1993; 128.79: 88.
Gilbert DN, Moellering RC, Eliopous GM, Chambers HF, Saag MS. The Sanford Guide to the Antimicrobial Therapy. 40th ed. 2010.
Palcic J. Odvzem, shranjevanje in transport kužnin za mikrobiološke preiskave. Maribor: Zavod za zdravstveno varstvo, Center za mikrobiologijo, 2004.
Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978 Oct; 49(4): 239–43.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, Centers for Disease Control AMD Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27: 97–132.
Suljagic V, Jevtic M, Djordjevic B, Jovelic A. Surgical site infection in a tertiary health care center:Prospective cohort study. Surg Today 20120; 40: 763–771.
Misteli H, Widmer AF, Rosenthal R, Oertli D, Marti WR, Weber WP. Spectrum of pathogens in surgical site infections at a Swiss universal hospital. Swiss Med Wkly 2011: 140:w13146.
Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical prpeparation solutions in foote AMD ankle surgery. The Journal of Bone AMD Joint Surgery 2005; 87-A; 5: 980–985.
Savages JW, Weatherford BM, Sugrue PA, Nolden MT, Liu JC, Song JK in sod. Efficacy of Surgical Preparation Solutions in Lumbar Spine Surgery 2012; 94-A; 6: 490–494.
Morrison S, White N, Asadollahi S, Lade J. Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery. ANZ Journal of Surgery 2012; 82: 902–907.
Slobogean GP, Kennedy SA, Davidson D, O,Brian PJ. Single – versus multiple dose antibiotic prophylaxis in the surgical treatment of closed fractures. A meta analysis. J Orthop. Trauma 2008; 22: 264–9.
Peel TN, Cheng AC, Buising KL, Choong PFM. Microbiological Aetology, Epidemiology, and Clinical Profile of Prosthesis Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective? Antibiotic Prophlaxis for Arthoplasty 2012; 56(5): 2386–2391.
Osei DA, Boyer MI. Preoperative Antibiotic Prophylaxis in the Penicilin–Allergic Patient. JHS 2012; 37A: 2623–2625.
Mangram AJ, Horan TC, Pearson ML, et. Guideline for prevention of surgical site infection 1999. Hospital Infection Control Practices Advisory Committee Infect Control Hosp Epidemiol 1999; 20: 250–278.
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