Japanese Society for Infection Prevention and Control-Online Journal

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Actions and Outcomes of Eliminating Postoperative Antimicrobial Agents in Lower Gastrointestinal Tract Surgery

Kyoko YAMAMOTO¹⁾ and Yuji ITOU²⁾
¹⁾Chutoen General Medical Center Nursing Department, ²⁾Chutoen General Medical Center Department of General Internal Medicine

Background: Perioperative antimicrobial therapy is used for the prevention of surgical site infection (SSI) in lower gastrointestinal tract surgery. The US Centers for Disease Control and Prevention guidelines recommend administering antibiotics before and during the surgery; nevertheless, an additional dose of antibiotics is administered for 3-4 days after surgery in Japan. Our hospital has been working on the initiative for the cessation of postoperative antimicrobials in the lower gastrointestinal tract surgery since November 2018. We aimed to investigate whether this initiative was associated with the increased incidence rate of SSIs.
Methods: We retrospectively collected the data for the elective colorectal or rectal surgery performed between February 2014 and April 2021 and compared the incidence rate of SSIs before and after we started the initiative in November 2018 (before: group A [545 patients]; after: group B [295 patients]).
Results: Multivariable logistic regression analysis showed no significant increase in the incidence rate of SSIs in group B than in group A (adjusted odds ratio [OR], 1.09 [95% confidence interval: 0.73-1.63]). A sensitivity analysis was conducted using the same regression analysis that was performed for 541 patients in group A who continued postoperative antimicrobial therapy and 241 patients in group B who did not receive postoperative therapy, with an OR of 1.20 [0.78-1.78]. Interrupted time series analysis showed no change in the incidence rate of SSIs before and after November 2018 (trend change −1.32% [−2.82%-0.17%]). Postoperative hospital stay duration was significantly shorter in group B than in group A (17.4±13 and 14.8±9.7 days, respectively, P = 0.004).
Conclusions: The incidence rate of SSIs did not increase after starting the initiative, and the duration of hospital stay was reduced. Retrospective analysis using data from a single center provided useful evidence on appropriate antimicrobial use for preventing SSIs in the perioperative setting.

Key words：antimicrobial stewardship, surgical antibiotic prophylaxis, surgical site infection, lower gastrointestinal surgery, interrupted time-series analysis

e-mail: kansen＠chutoen-hp.shizuoka.jp

Received: December 13, 2022
Accepted: March 25, 2023

38 (4)：192─199,2023