Association of Prophylactic Antibiotic Guideline Non-Adherence with Surgical Site Infections in Patients Receiving Perioperative Vancomycin: Results from a Multi-Institutional Combined NSQIP and MPOG Registry.

Objective: To investigate whether non-adherence to the combined Infectious Disease Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA) guideline based antibiotic choice, timing, and/or dose of vancomycin was associated with Surgical Site infections in surgeries where vancomycin was administered.

Summary Background Data: Despite the pivotal role of antibiotics in preventing surgical site infections (SSIs), widespread non-adherence to IDSA/SIS/SHEA guidelines especially related to vancomycin for intraoperative antibiotic prophylaxis continues. It is unclear whether this non-adherence is associated with SSIs.

Methods: In this multicenter observational study, we utilized integrated data from Multicenter Perioperative Outcomes Group (MPOG) registry, the National Surgical Quality Improvement Program (NSQIP) and Michigan Surgical Quality Collaborative (MSQC) registries encompassing 31 academic and community hospitals for surgeries from 01/01/2014 to 08/31/2022. Patients over 18 years of age who underwent non-cardiac procedures involving a skin incision and who were administered Vancomycin were included. The co-primary exposures were non-adherence to IDSA/SIS/SHEA guidelines with respect to choice, dose, or timing, and the primary outcome was NSQIP/MSQC-coded SSI. A hierarchical generalized linear mixed model with surgical patients nested within MPOG institutions was performed.

Results: A total of 5542 unique cases met the inclusion criteria, 55.5% participants were women, and the mean (SD) age was 60.0 (14.3) years. The incidence of SSI was 5.6% in the cohort. Non-adherence to guideline-based antibiotic choice, dosing and timing was 705 (12.7%), 59 (1.1%) and 197 (3.6%) respectively. In adjusted analysis, non-adherence to antibiotic choice [RR (95% CI): 1.64 (1.17, 2.31), P =0.004], and timing [RR (95% CI): 1.56 (1.01, 2.40), P=0.043] were significantly independently associated with SSI.

Conclusions: Guideline adherent antibiotic choice (IDSA/SIS/SHEA metric) and time of vancomycin administration (IDSA/SIS/SHEA and SCIP metric) are associated with reduced odds of Surgical Site Infections in patients receiving perioperative vancomycin prophylaxis.