Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 1;6(6):e2317370.
doi: 10.1001/jamanetworkopen.2023.17370.

Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

Rami Sommerstein  1   2   3 , Nicolas Troillet  1   4 , Stephan Harbarth  1   5 , Marlieke E A de Kraker  5 , Danielle Vuichard-Gysin  1   6 , Stefan P Kuster  7 , Andreas F Widmer  1   8 ; Swissnoso group
Collaborators, Affiliations

Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

Rami Sommerstein et al. JAMA Netw Open. .

Abstract

Importance: World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited.

Objective: To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI).

Design, setting, and participants: This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023.

Exposures: Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol.

Main outcomes and measures: Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied.

Results: Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P < .001), as was SAP administration 31 to 60 minutes prior to incision (aOR, 0.91; 95% CI, 0.84-0.98; P = .01) compared with administration 61 to 120 minutes prior to incision. Administration 10 to 25 minutes prior to incision in 45 448 patients (20.4%) was significantly associated with a lower SSI rate (aOR, 0.89; 95% CI, 0.82-0.97; P = .009) vs administration within 30 to 55 minutes prior to incision in 117 348 patients (52.8%).

Conclusions and relevance: In this cohort study, administration of cefuroxime SAP closer to the incision time was associated with significantly lower odds of SSI, suggesting that cefuroxime SAP should be administrated within 60 minutes prior to incision, and ideally within 10 to 25 minutes.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Harbarth reported receiving grants from the European Commission outside the submitted work. Professor de Kraker reported receiving grants from the Innovative Medicines Initiative/European Union/European Federation of Pharmaceutical Industries and Associations (IMI2/EU/EFPIA) Joint Undertaking Predicting the Impact of Monoclonal Antibodies and Vaccines on Antimicrobial Resistance (PrIMAVeRa) grant no 101034420, and IMI Joint Undertaking under grant agreements numbers, 115620, and 115737 for Combatting Bacterial Resistance in Europe (COMBACTE) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Flowchart
Figure 2.
Figure 2.. Crude Surgical Site Infection (SSI) Rate Relative to Timing of Surgical Antimicrobial Prophylaxis (SAP)
Graph shows crude SSI rate relative to timing of SAP administration per 10-minute timing window. For example, −15 minutes stands for SAP administration in the time window −19 to −10 minutes prior to incision. Bars denote 95% CIs, and dots denote mean SSI rate.
See this image and copyright information in PMC

References

    1. Magill SS, Edwards JR, Bamberg W, et al. ; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team . Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801 - DOI - PMC - PubMed
    1. Suetens C, Latour K, Kärki T, et al. ; Healthcare-Associated Infections Prevalence Study Group . Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516. doi:10.2807/1560-7917.ES.2018.23.46.1800516 - DOI - PMC - PubMed
    1. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725-730. doi:10.1086/501572 - DOI - PubMed
    1. Allegranzi B, Bischoff P, de Jonge S, et al. ; WHO Guidelines Development Group . New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-e287. doi:10.1016/S1473-3099(16)30398-X - DOI - PubMed
    1. Allegranzi B, Zayed B, Bischoff P, et al. ; WHO Guidelines Development Group . New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-e303. doi:10.1016/S1473-3099(16)30402-9 - DOI - PubMed

Publication types