{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:57:43Z","timestamp":1786687063917,"version":"build-2736575974"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T00:00:00Z","timestamp":1676160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Epidemiology"},{"DOI":"10.13039\/100008510","name":"University of Maryland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008510","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008235","name":"School of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008235","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019\u20132020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61\u20131.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91\u2013.94; P &amp;lt; .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11\u20131.27; P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad077","type":"journal-article","created":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T07:11:52Z","timestamp":1676185912000},"page":"2106-2115","source":"Crossref","is-referenced-by-count":25,"title":["Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019\u20132020"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3617-0701","authenticated-orcid":false,"given":"Stephanie M","family":"Cabral","sequence":"first","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony D","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence S","family":"Magder","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranita D","family":"Tamma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2851-775X","authenticated-orcid":false,"given":"Katherine E","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,12]]},"reference":[{"key":"2023061611265846500_ciad077-B1","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1086\/644617","article-title":"The European Surveillance of Antimicrobial Consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006","volume":"49","author":"Ansari","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B2","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1093\/jac\/dkr571","article-title":"Point prevalence survey of antibiotic use in French hospitals in 2009","volume":"67","author":"Robert","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2023061611265846500_ciad077-B3","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1001\/jama.2014.12923","article-title":"Prevalence of antimicrobial use in US acute care hospitals, May-September 2011","volume":"312","author":"Magill","year":"2014","journal-title":"JAMA"},{"key":"2023061611265846500_ciad077-B4","doi-asserted-by":"crossref","first-page":"e1002340","DOI":"10.1371\/journal.pmed.1002340","article-title":"Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective cohort study","volume":"14","author":"Branch-Elliman","year":"2017","journal-title":"PLoS Med"},{"key":"2023061611265846500_ciad077-B5","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1001\/jama.2019.20830","article-title":"Preventing surgical site infections: looking beyond the current guidelines","volume":"323","author":"Fields","year":"2020","journal-title":"JAMA"},{"key":"2023061611265846500_ciad077-B6","doi-asserted-by":"crossref","first-page":"e0179117","DOI":"10.1371\/journal.pone.0179117","article-title":"Antibiotic prophylaxis for surgical site infections as a risk factor for infection with Clostridium difficile","volume":"12","author":"Balch","year":"2017","journal-title":"PLoS One"},{"key":"2023061611265846500_ciad077-B7","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1001\/jamasurg.2019.0569","article-title":"Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events","volume":"154","author":"Branch-Elliman","year":"2019","journal-title":"JAMA Surg"},{"key":"2023061611265846500_ciad077-B8","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11999-014-4062-3","article-title":"Addition of vancomycin to cefazolin prophylaxis is associated with acute kidney injury after primary joint arthroplasty","volume":"473","author":"Courtney","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"2023061611265846500_ciad077-B9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1089\/sur.2013.9999","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"14","author":"Bratzler","year":"2013","journal-title":"Surg Infect"},{"key":"2023061611265846500_ciad077-B10","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"key":"2023061611265846500_ciad077-B11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.bjid.2015.06.004","article-title":"Adherence to guidelines for surgical antibiotic prophylaxis: a review","volume":"19","author":"Gouv\u00eaa","year":"2015","journal-title":"Braz J Infect Dis"},{"key":"2023061611265846500_ciad077-B12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.amjsurg.2009.07.050","article-title":"Compliance with guidelines to prevent surgical site infections: as simple as 1\u20132\u20133?","volume":"201","author":"Meeks","year":"2011","journal-title":"Am J Surg"},{"key":"2023061611265846500_ciad077-B13","first-page":"253","article-title":"Iranian surgeons\u2019 compliance with the American Society of Health-System Pharmacists guidelines: antibiotic prophylaxis in private versus teaching hospitals","volume":"4","author":"Mahdaviazad","year":"2011","journal-title":"J Infect Chemother"},{"key":"2023061611265846500_ciad077-B14","first-page":"126","article-title":"An audit of perioperative antimicrobial prophylaxis: compliance with the international guidelines","volume":"6","author":"Mousavi","year":"2017","journal-title":"Am J Pharmacogenomics"},{"key":"2023061611265846500_ciad077-B15","doi-asserted-by":"crossref","first-page":"e1915003","DOI":"10.1001\/jamanetworkopen.2019.15003","article-title":"Appropriateness of surgical antimicrobial prophylaxis practices in Australia","volume":"2","author":"Ierano","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2023061611265846500_ciad077-B16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13643-021-01577-w","article-title":"Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review","volume":"10","author":"Hassan","year":"2021","journal-title":"Syst Rev"},{"key":"2023061611265846500_ciad077-B17","doi-asserted-by":"crossref","first-page":"e2137296","DOI":"10.1001\/jamanetworkopen.2021.37296","article-title":"Adherence to guidelines for the administration of intraoperative antibiotics in a nationwide US sample","volume":"4","author":"Bardia","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2023061611265846500_ciad077-B18","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ijsu.2020.05.022","article-title":"Impact of the coronavirus (COVID-19) pandemic on surgical practice\u2014part 1","volume":"79","author":"Al-Jabir","year":"2020","journal-title":"Int J Surg"},{"key":"2023061611265846500_ciad077-B19","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1186\/s12893-020-00970-x","article-title":"The COVID-19 pandemic: impact on surgical departments of non-university hospitals","volume":"20","author":"St\u00f6\u00df","year":"2020","journal-title":"BMC Surg"},{"key":"2023061611265846500_ciad077-B20","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1177\/0003134820945203","article-title":"The impact of the COVID-19 pandemic on surgical practice in the southeastern United States: results of a survey of the membership of the southeastern surgical congress","volume":"86","author":"Richmond","year":"2020","journal-title":"Am Surg"},{"key":"2023061611265846500_ciad077-B21","doi-asserted-by":"crossref","first-page":"e533","DOI":"10.1093\/cid\/ciaa1239","article-title":"Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with coronavirus disease 2019 (COVID-19): a multi-hospital cohort study","volume":"72","author":"Vaughn","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B22","doi-asserted-by":"crossref","first-page":"e0134121","DOI":"10.1128\/AAC.01341-21","article-title":"Antibiotic use and bacterial infection among inpatients in the first wave of COVID-19: a retrospective cohort study of 64,691 patients","volume":"65","author":"Baghdadi","year":"2021","journal-title":"Antimicrob Agents Chemother"},{"key":"2023061611265846500_ciad077-B23","author":"PINC AI Applied Sciences","year":"2022"},{"key":"2023061611265846500_ciad077-B24","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/cid\/ciaa570","article-title":"Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016\u20132017","volume":"73","author":"Goodman","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B25","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jtcvs.2015.09.090","article-title":"Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery","volume":"151","author":"Poeran","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023061611265846500_ciad077-B26","doi-asserted-by":"crossref","first-page":"e1224","DOI":"10.1093\/cid\/ciac504","article-title":"Patterns, predictors, and intercenter variability in empiric gram-negative antibiotic use across 928 United States hospitals","volume":"76","author":"Goodman","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B27","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1017\/ice.2017.129","article-title":"The effect of adding comorbidities to current centers for disease control and prevention central-line\u2013associated bloodstream infection risk-adjustment methodology","volume":"38","author":"Jackson","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2023061611265846500_ciad077-B28","author":"Centers for Disease Control and Prevention"},{"key":"2023061611265846500_ciad077-B29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1089\/sur.2011.033","article-title":"Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment","volume":"12","author":"Sanchez","year":"2011","journal-title":"Surg Infect"},{"key":"2023061611265846500_ciad077-B30"},{"key":"2023061611265846500_ciad077-B31"},{"key":"2023061611265846500_ciad077-B32","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/2042098614554919","article-title":"Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem","volume":"5","author":"Llor","year":"2014","journal-title":"Ther Adv Drug Saf"},{"key":"2023061611265846500_ciad077-B33","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.3390\/molecules25061340","article-title":"Resistance of gram-negative bacteria to current antibacterial agents and approaches to resolve it","volume":"25","author":"Breijyeh","year":"2020","journal-title":"Molecules"},{"key":"2023061611265846500_ciad077-B34"},{"key":"2023061611265846500_ciad077-B35","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1001\/jama.299.10.1149","article-title":"Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients","volume":"299","author":"Harbarth","year":"2008","journal-title":"JAMA"},{"key":"2023061611265846500_ciad077-B36","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1093\/cid\/ciy507","article-title":"Methicillin-resistant Staphylococcus aureus colonization and pre- and post-hospital discharge infection risk","volume":"68","author":"Nelson","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B37","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ajic.2012.02.001","article-title":"National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010","volume":"40","author":"Jarvis","year":"2012","journal-title":"Am J Infect Control"},{"key":"2023061611265846500_ciad077-B38","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1001\/jama.2015.5387","article-title":"Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery","volume":"313","author":"Schweizer","year":"2015","journal-title":"JAMA"},{"key":"2023061611265846500_ciad077-B39","doi-asserted-by":"crossref","first-page":"2702","DOI":"10.1007\/s11999-012-2255-1","article-title":"Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty?","volume":"470","author":"Sewick","year":"2012","journal-title":"Clin Orthop Relat Res"},{"key":"2023061611265846500_ciad077-B40","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1089\/sur.2009.055","article-title":"Glycopeptide vs. non-glycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review","volume":"11","author":"Chambers","year":"2010","journal-title":"Surg Infect"},{"key":"2023061611265846500_ciad077-B41","doi-asserted-by":"crossref","first-page":"e4113","DOI":"10.1093\/cid\/ciaa1787","article-title":"Impact of sex and metabolic comorbidities on coronavirus disease 2019 (COVID-19) mortality risk across age groups: 66 646 inpatients across 613 U.S. hospitals","volume":"73","author":"Goodman","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B42","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1001\/jamainternmed.2016.5651","article-title":"Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012","volume":"176","author":"Baggs","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2023061611265846500_ciad077-B43","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1093\/cid\/cir672","article-title":"Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals","volume":"53","author":"Polk","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2023061611265846500_ciad077-B44","first-page":"1234","article-title":"Validation of administrative coding and clinical notes for hospital-acquired acute kidney injury in adults","volume":"2021","author":"Zhang","year":"2021","journal-title":"AMIA Annu Symp Proc"},{"key":"2023061611265846500_ciad077-B45","doi-asserted-by":"crossref","first-page":"682","DOI":"10.2215\/CJN.07650713","article-title":"Performance and limitations of administrative data in the identification of AKI","volume":"9","author":"Grams","year":"2014","journal-title":"Clin J Am Soc Nephrol"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciad077\/49401077\/ciad077.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/12\/2106\/50626474\/ciad077.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/12\/2106\/50626474\/ciad077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T11:28:37Z","timestamp":1686914917000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/76\/12\/2106\/7034632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,12]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,2,12]]},"published-print":{"date-parts":[[2023,6,16]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciad077","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6,15]]},"published":{"date-parts":[[2023,2,12]]}}}