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
Multicenter Study
. 2026 Feb 2;9(2):e2559349.
doi: 10.1001/jamanetworkopen.2025.59349.

Guideline Adherence of Perioperative Antibiotics and Surgical Site Infections in Noncardiac Surgery

Amit Bardia  1 , Hung-Mo Lin  2   3 , Xiwen Zhao  3 , George Michel  3 , Mabel Wai  4 , Clark Fisher  2 , Kevin M Shuster  5 , Douglas A Colquhoun  6 , Michael R Mathis  6 , Michael McGee  7 , Sachin Kheterpal  6 , Jill Mhyre  8 , Robert B Schonberger  2
Affiliations
Multicenter Study

Guideline Adherence of Perioperative Antibiotics and Surgical Site Infections in Noncardiac Surgery

Amit Bardia et al. JAMA Netw Open. .

Abstract

Importance: Despite nearly universal adherence to the Surgical Care Improvement Project (SCIP), surgical site infections (SSIs) persist. Compared with SCIP, which largely focuses on antibiotic timing, the Infectious Diseases Society of America (IDSA) guidelines provide a more comprehensive framework of antibiotic metrics, including procedure-specific antibiotic selection, weight-adjusted dosing, timing of the first dose, and appropriate redosing.

Objective: To assess whether nonadherence to each antibiotic administration metric of IDSA guidelines is associated with SSIs.

Design, setting, and participants: In this nationwide, multicenter, cross-sectional study, patients aged 18 years or older who underwent noncardiac surgeries involving a skin incision between January 1, 2014, and August 31, 2022, were included from merged data of the Multicenter Perioperative Outcomes Group, National Surgical Quality Improvement Program, and Michigan Surgical Quality Collaborative registries. Analyses were conducted between July 2, 2024, and April 24, 2025.

Exposure: Nonadherence to IDSA-defined antibiotic metrics.

Main outcomes and measures: The primary end point was SSI, defined as any superficial, deep tissue, or organ-space infection as recorded in the National Surgical Quality Improvement Program and Michigan Surgical Quality Collaborative registries. The association of nonadherence to IDSA guidelines (both overall and individually) was examined using hierarchical generalized linear mixed models.

Results: Of 134 413 eligible surgical cases, a total of 119 236 patients (mean [SD] age, 56.2 [15.9] years; 58.1% women) from 37 institutions met the inclusion criteria, among whom 6796 (5.7%) had incomplete covariate data. Failure to adhere to any IDSA metric was common in 26.1% of cases, with individual nonadherence rates as follows: 13.3% for antibiotic choice, 9.0% for weight-adjusted dosing, 3.0% for timing relative to incision, and 4.8% for correct intraoperative redosing interval. Overall, SSIs occurred in 4.4% of cases. After adjusted analysis, guideline-nonadherent antibiotic administration was significantly associated with SSIs (relative risk [RR], 1.34 [95% CI, 1.26-1.43]). Nonadherence to antibiotic choice (RR, 1.43 [95% CI, 1.33-1.53]) and failure to appropriately redose intraoperatively (RR, 1.12 [95% CI, 1.02-1.24]) were significantly associated with SSIs.

Conclusions and relevance: This cross-sectional study found that IDSA guideline nonadherence, including incorrect antibiotic choice and missed intraoperative redosing, was common and associated with increased SSI risk, despite high adherence to SCIP timing metrics. Improving adherence to IDSA-recommended antibiotic selection and redosing may meaningfully reduce SSIs.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bardia reported receiving consultant fees from Takeda Pharmaceuticals outside the submitted work. Dr Fisher reported having owned stock from Johnson & Johnson outside the submitted work. Dr Colquhoun reported receiving research support paid to his employer from GE Healthcare, Chiesi USA, and Merck & Co outside the submitted work. Dr Mathis reported receiving research support paid to his institution from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute; NIH National Institute of Diabetes and Digestive and Kidney Diseases; and Chiesi USA outside the submitted work. Dr Schonberger reported owning stock in Johnson & Johnson and receiving grants from Merck outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Bar Graphs of Patterns of Infectious Diseases Society of America Guideline Nonadherence and Associated Surgical Site Infection (SSI) Rates
B, The UpSet-style matrix below the bar graph illustrates which antibiotic metrics were not adhered to (black circles) in each pattern.
Figure 2.
Figure 2.. Dot Plot of the Association Between Nonadherence to Guideline-Based Antibiotic Administration and Surgical Site Infections (SSIs)
Each dot indicates a center, the line indicates the best fit, and the shaded area represents the 95% CI.
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. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi: 10.1086/676022 - DOI - PMC - PubMed
    1. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244-252. doi: 10.1001/jama.2022.24075 - DOI - PubMed
    1. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. ; Healthcare Infection Control Practices Advisory Committee . Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi: 10.1001/jamasurg.2017.0904 - DOI - PubMed
    1. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101-114. doi: 10.1086/657912 - DOI - PubMed

Publication types

Substances