Longer Postsurgical Antibiotic Treatment Could Do More Harm Than Good

New research suggested that longer durations of postoperative antibiotic treatment does not lead to additional surgical-site infection prevention and is in fact associated with an increased risk of acute kidney injury and Clostridium difficile infection.

To explore how the duration of antimicrobial prophylaxis affects postoperative outcomes, the researchers conducted a multicenter, national retrospective cohort study involving 79,058 patients from the national Veterans Affairs health care system who had undergone cardiac, orthopedic total joint replacement, colorectal, and vascular procedures from October 1, 2008 to September 30, 2013.

Following stratification by type of surgery and adjustment for various factors, they found that risk of surgical site infection was not associated with the duration of prophylaxis. Further, adjusted odds of acute kidney injury increased with each additional day of phophylaxis, as did the risk of C difficile infection.

The unadjusted numbers needed to harm for acute kidney injury were 9, 6, and 4 after 24 to less than 48 hours, 48 to less than 72 hours, and 72 hours or more of postoperative prophylaxis, respectively. For C difficile infection, the unadjusted numbers needed to harm were 2000, 90, and 50 after 24 to less than 48 hours, 48 to less than 72 hours, and 72 hours or more of postoperative prophylaxis, respectively.

“These findings highlight the notion that every day matters and suggest that stewardship efforts to limit duration of prophylaxis have the potential to reduce adverse events without increasing surgical site infections.”

—Michael Potts

Reference:

Branch-Elliman W, O’Brien W, Strymish J, et al. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events [published online April 24, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.0569