Optimal timing of cefuroixime surgical antimicrobial prophylaxis may decrease surgical site infection risk

1. Among 538,967 adult participants who underwent major surgery, administration of prophylactic cefuroxime at 0-30 or 31-60 minutes resulted in a significantly lower risk of surgical site infections, compared to administration at 61-120 minutes. 

Evidence Rating Level: 3 (Average)

Surgical site infections (SSIs) are an important healthcare concern, given that they account for nearly 20% of all healthcare-related infections. Though current WHO guidelines recommend providing antibiotics 120 minutes prior to surgery, there is a scarcity in literature characterizing the optimal time of antibiotic administration. In this cohort study, researchers aimed to assess whether the timing of cefuroxime administration impacted the incidence of surgical site infections. The study included 538,967 adult participants who underwent major surgery between January 2009 and December 2020 in Switzerland, documented by the Swissnoso SSI surveillance system. Participants were divided into three groups based on the timing of cefuroxime prophylaxis prior to the first incision: 0-30 minutes (34.7%), 31-60 minutes (53.1%), and 61-120 minutes (12.2%). 5355 (2.4%) of patients developed an SSI. Compared to the 61-120 minute group, a lower rate of surgical site infections was found with cefuroxime administration at 0-30 minutes (adjusted odds ratio, 0.85; 95% CI, 0.78-0.93; P < .001) and 31-60 minutes (aOR, 0.91; 95% CI, 0.84-0.98; P = .01). Findings indicate that the current guidelines may not reflect best practices, and patients may benefit from antibiotics closer to the time of incision. An important limitation of this study is that the authors did not adjust for confounding variables that likely impact the incidence of infection, such as diabetes, smoking, immunodeficiency, or the type of surgery performed. Although further research in the area is required prior to guideline and practice changes, study findings may indicate that changing antibiotic prophylaxis closer to time of incision may be a simple but effective strategy in decreasing SSIs.

Click to read the study in JAMA Network Open

Image: PD

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