Abstract：
There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives.
We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence.
Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001).
Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.
We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence.
Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001).
Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.
摘要：
背景：评估外科抗菌药物预防指南依从性的美国数据有限，特别是在一个大的，全国样本。此外，通常规定的不适当的抗菌预防方案仍然未知，阻碍改进举措。
方法：我们对接受择期开颅手术的成年人进行了回顾性队列研究，髋关节置换,膝关节置换,脊柱手术,或2019-2020年在PINCAI（Premier）医疗保健数据库中的医院进行疝气修复。我们评估了预防方案的依从性，关于美国卫生系统药剂师指南中认可的抗微生物剂，考虑患者抗生素过敏和耐甲氧西林金黄色葡萄球菌的定植状态。我们使用医院随机效应的多变量逻辑回归来评估患者之间的关联，程序,以及医院特点和指导方针的依从性。
结果：在825家医院和521,091例住院择期手术中，308,760（59％）遵守预防指南。在调整后的分析中，不同美国人口普查部门的依从性差异显著(调整后OR[aOR]范围:0.61-1.61),2020年与2019年相比显著降低(aOR0.92,95%CI:0.91-0.94,p<0.001).不依从的最常见原因是不必要的万古霉素使用。在事后分析中，控制患者年龄，合并症,其他肾毒性剂的使用，以及患者和手术特征，与单用头孢唑啉的患者相比,接受头孢唑啉联合万古霉素的患者发生急性肾损伤(AKI)的几率高出19%(aOR1.19;95%CI:1.11~1.27,p<0.001).
结论：对抗菌药物预防指南的依从性仍不理想，很大程度上是由于不必要的万古霉素的使用，这可能会增加AKI的风险。在COVID-19大流行的第一年，依从性下降。
方法：我们对接受择期开颅手术的成年人进行了回顾性队列研究，
结果：在825家医院和521,091例住院择期手术中，
结论：对抗菌药物预防指南的依从性仍不理想，
