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
. 2025 Aug 20.
doi: 10.1097/SLA.0000000000006903. Online ahead of print.

Association of Prophylactic Antibiotic Guideline Non-Adherence with Surgical Site Infections in Patients Receiving Perioperative Vancomycin: Results from a Multi-Institutional Combined NSQIP and MPOG Registry

Amit Bardia  1 , Hung-Mo Lin  2 , George Michel  3 , Clark Fisher  2 , Xiwen Zhao  2 , Kevin Shuster  4 , Douglas A Colquhoun  5 , Michael R Mathis  5 , Megan Anders  6 , Sachin Kheterpal  5 , Robert B Schonberger  2
Affiliations

Association of Prophylactic Antibiotic Guideline Non-Adherence with Surgical Site Infections in Patients Receiving Perioperative Vancomycin: Results from a Multi-Institutional Combined NSQIP and MPOG Registry

Amit Bardia et al. Ann Surg. .

Abstract

Objective: To investigate whether non-adherence to the combined Infectious Disease Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA) guideline based antibiotic choice, timing, and/or dose of vancomycin was associated with Surgical Site infections in surgeries where vancomycin was administered.

Summary background data: Despite the pivotal role of antibiotics in preventing surgical site infections (SSIs), widespread non-adherence to IDSA/SIS/SHEA guidelines especially related to vancomycin for intraoperative antibiotic prophylaxis continues. It is unclear whether this non-adherence is associated with SSIs.

Methods: In this multicenter observational study, we utilized integrated data from Multicenter Perioperative Outcomes Group (MPOG) registry, the National Surgical Quality Improvement Program (NSQIP) and Michigan Surgical Quality Collaborative (MSQC) registries encompassing 31 academic and community hospitals for surgeries from 01/01/2014 to 08/31/2022. Patients over 18 years of age who underwent non-cardiac procedures involving a skin incision and who were administered Vancomycin were included. The co-primary exposures were non-adherence to IDSA/SIS/SHEA guidelines with respect to choice, dose, or timing, and the primary outcome was NSQIP/MSQC-coded SSI. A hierarchical generalized linear mixed model with surgical patients nested within MPOG institutions was performed.

Results: A total of 5542 unique cases met the inclusion criteria, 55.5% participants were women, and the mean (SD) age was 60.0 (14.3) years. The incidence of SSI was 5.6% in the cohort. Non-adherence to guideline-based antibiotic choice, dosing and timing was 705 (12.7%), 59 (1.1%) and 197 (3.6%) respectively. In adjusted analysis, non-adherence to antibiotic choice [RR (95% CI): 1.64 (1.17, 2.31), P =0.004], and timing [RR (95% CI): 1.56 (1.01, 2.40), P=0.043] were significantly independently associated with SSI.

Conclusions: Guideline adherent antibiotic choice (IDSA/SIS/SHEA metric) and time of vancomycin administration (IDSA/SIS/SHEA and SCIP metric) are associated with reduced odds of Surgical Site Infections in patients receiving perioperative vancomycin prophylaxis.

Keywords: IDSA/SIS/SHEA guidelines; surgical site infections; vancomycin.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Dr Schonberger owns stock in Johnson & Johnson unrelated to the present study, and his institution has received research support from Merck, Inc, for a study in which he participated unrelated to the present work. Dr. Bardia served as a consultant for Takeda pharmaceuticals for a drug unrelated to present study. Dr. Mathis has received research grants from the US National Institutes of Health (NHLBI, NIDDK). Dr Mathis and Colquhoun report research support paid to the University of Michigan from Chiesi, USA (Cary, NC) unrelated to this present work. Dr Colquhoun reports research support from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., (Rahway, New Jersey) paid to the University of Michigan unrelated to presented work. Dr Colquhoun reports receiving an honorarium from Medscape, Inc (New York, New York).

LinkOut - more resources