SRS176 - Targeted antibiotic prophylaxis to reduce surgical site infection in lower limb vascular surgery

Abstract Objective The aim of this study was to investigate if revising antibiotic prophylaxis protocols for lower limb vascular surgery, specifically for both the surgical site and local resistance patterns could reduce rates of SSI. Design/Methods This pre-post cohort study recruited adult patients undergoing lower limb vascular surgery. Cohort 1 consisted of patients receiving generic single agent co-amoxiclav prophylaxis and cohort 2 received targeted prophylaxis. Targeted prophylaxis guidelines were developed using the data available locally and reported nationally in regional quarterly reports. This data was compared to national guidelines on both general and vascular surgery specific antibiotics prophylaxis and a literature search on vascular surgery antibiotic prophylaxis. The primary outcome was SSI at 30 days post-surgery, defined by CDC criteria/ASEPSIS scores. Results Of the 191 participants recruited to the study, 171 were included in data analysis. There were 48 (28%) SSIs recorded overall. In cohort 1 there were 30/75 (40%) SSIs and in cohort 2 there were 18/96 (19%) SSIs, an absolute risk reduction of 21% (P = 0.002) with targeted antibiotic prophylaxis. Odds ratio logistic regression identified antibiotic protocol (P = 0.017) and BMI (P = 0.009) to significantly influence SSI incidence. Targeted antibiotic prophylaxis (cohort 2) resulted in an almost threefold reduction in the risk of SSI compared to cohort 1 (OR, 0.281; 95% c.i., 0.1–0.79). Conclusions Updating and targeting surgical antibiotic prophylaxis significantly reduced SSI rates in this patient group. Vascular departments should work collaboratively with infection management teams to target prophylaxis.