Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019)

Meeting abstracts
Open Access
Published: 09 September 2019

Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019)

Antimicrobial Resistance & Infection Control 8, Article number: 148 (2019) | Download Citation

Slide session: Surgical Site Infection

O1 THE EFFECT OF POSTOPERATIVE CONTINUATION OF ANTIBIOTIC PROPHYLAXIS ON THE INCIDENCE OF SURGICAL SITE INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

S. De Jonge1, Q. Boldingh1, J. Solomkin2, P. Dellinger3, M. Egger4, G. Salanti4, B. Allegranzi5, M. Boermeester1

1Surgery, Amsterdam UMC, Amsterdam, Netherlands; 2Surgery, University of Cincinnati , Cincinnati; 3Surgery, University of Washington, Seatle, United States; 4Institute for Social and Preventive Medicine, University of Bern, Bern; 5Infection Prevention and Control Global Unit, World Health Organization, Geneva, Switzerland

Correspondence: S. De Jonge

Introduction: Surgical antibiotic prophylaxis (SAP) is frequently continued for several days after surgery to prevent surgical site infection (SSI).Continuing SAP after the operation may have no advantage compared to immediate discontinuation and unnecessarily expose patients to risks associated with antibiotic use. In 2016, the World Health Organization (WHO) recommended discontinuation of SAP.

Objectives: We present an update of the evidence that formed the basis for this recommendation.

Methods: For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, CENTRAL, and WHO regional medical databases from Jan 1990 to August 2018 for randomised controlled trials (RCT) comparing the effect of postoperative SAP continuation to its discontinuation. We excluded studies comparing regimens that also differed with regard to dose and agent used, and studies that did not administer the first dose preoperatively by intravenous infusion. We extracted data from published reports and contacted the authors if important information was missing. We combined studies using random effects meta-analysis. We planned subgroup analyses and meta-regression for studies adhering to current standards of practice in SAP.

Results: We identified 83 relevant RCTs. The main meta-analysis included 52RCTs with 19,273 participants. The combined relative risk of SSI comparing postoperative SAP continuation with discontinuation was 0·89 (95% confidence interval: 0·79-1·00). There was little heterogeneity (tau2: 0·001). Subgroup analysis showed that the effectiveness of postoperatively discontinued SAP depends on appropriateness of SAP practices. When SAP best practices (i.e., timely administration of the first dose and redosing when indicated according to the procedure duration) were applied, there was no benefit of postoperative SAP continuation in reducing SSI compared to discontinuation of SAP.

Conclusion: There is no strong evidence for a benefit of postoperative continuation of SAP. These findings support WHO recommendations against this practice. A protocol for this review was registered with at PROSPERO:CRD42017060829.

Disclosure of Interest: None declared