Prevalence of cultures, sensitivity testing and antibiotic use among SSI studies: a query of the top surgical journals

Author(s):
Kaylie Machutta; Jason Xiao; Callie Winters; Jordan Perrott; Swathikan Chidambaram; James Kinross; Ryan Morgan; Tanvi Subramanian; Adam Cifu; John Alverdy

Background:

Studies addressing surgical site infections (SSIs) published in surgical journals rarely if ever report culture results, antibiotic sensitivities and the antibiotics used for prophylaxis. As such, recommendations in the absence of this information are limited in their application to evidence-based practice. The aim of this study is to quantify the degree to which these 3 key features are absent among 4 of the most highly ranked non-specialty surgical journals over the last 5 years of publication.

Hypothesis:

We hypothesized that SSI-related publications from the top four non-specialty surgical journals routinely omit the following information: 1. How an SSI is defined, 2. the presence of bacterial cultures, 3. reporting of antibiotic sensitivity data, and 4. identification of the antibiotic chosen for prophylaxis.

Methods:

A systematic review evaluating surgical site infections from four highly cited non-specialty surgical journals, Annals of Surgery, the British Journal of Surgery, JAMA Surgery and the Journal of the American College of Surgeons was conducted for articles published between 2016-2021. We focused our extraction on data regarding SSI characteristics, SSI definition, interventions, use and reporting of bacterial cultures, reporting of antibiotic  prophylaxis, recommendations made, and use of sensitivity and resistance testing.

Results:

Of the 71 studies included, 32 diagnosed SSIs based on criteria developed by the Centers for Disease Control alone while 5 provided no definition of SSI. Of the 21 articles recommending increasing antibiotic usage, only one study performed antibiotic sensitivity testing to guide antibiotic choice. Of the total 71 studies reviewed, only 1 reported all of the key features considered to be necessary for SSI antibiotic decision making; 46 reported none of the key features.

Figure. Among 71 included publications, 1% (n=1) included all three criteria (1. culture results, 2. antibiotic sensitivity, 3. antibiotics used for prophylaxis). 7% (n=5) included any combination of two criteria, 27% (n=19) included only one criterion, and 65% (n=46) included none.

Conclusions:

Among the most highly read non-specialty surgical journals examining SSIs, bacterial cultures, antibiotic sensitivity data, and the antibiotics used for prophylaxis are routinely not reported. Given that today, as many as 50% of all SSIs are estimated to be resistant to the antibiotics chosen for prophylaxis, absence of this key information presents a major limitation to reduce SSIs beyond empirical measures.