Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision .
Abstract The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis ( SAP ) on  surgical site infection ( SSI )  and compare the different timing intervals .
The benefit of routine use of SAP prior to surgery has long been recognized .
However , the optimal timing has not been defined .
Timing of vancomycin prophylaxis for cardiac surgery patients and the risk of surgical site infections.
BACKGROUND Increased incidence of methicillin-resistant Staphylococcus species has required some hospitals to choose vancomycin for surgical prophylaxis . Guidelines for appropriate timing of vancomycin prophylaxis state that the infusion should begin within 120 min before the first surgical incision . However , no studies have investigated the proper timing of vancomycin prophylaxis in relationship to surgical site infections ( SSI ) . The objective of the present study was to assess the effect of vancomycin prophylaxis timing in relation to the first surgical incision on the incidence of SSI . METHODS We prospect ively monitored vancomycin prophylaxis timing and incidence of SSI in 2048 patients undergoing coronary bypass graft or valve replacement surgery . The timing of vancomycin was categorized into five groups based on the relation between the start of the infusion and the surgical cut time . Study hypotheses were tested using logistic analysis and further vali date d using a Heckman two-stage model . RESULTS The incidence of SSI were lowest in the 176 patients given vancomycin between 16 and 60 min before the surgical incision ( 3.4 % ) compared with 15 patients given vancomycin between 0 and 15 min [ 26.7 % ; relative risk ( RR ) : 7.8 ; 95 % CI : 2.5 - 24.7 ] , 888 patients given vancomycin between 61 and 120 min ( 7.7 % ; RR : 2.2 ; 95 % CI : 0.99 - 5.09 ) , 700 patients given vancomycin between 121 and 180 min ( 6.9 % ; RR : 2.0 ; 95 % CI : 0.87 - 4.62 ) or 269 patients given vancomycin > 180 min ( 7.8 % ; RR : 2.3 ; 95 % CI : 0.94 - 5.56 ) ( P = 0.0119 by chi(2 ) analysis ) . Stepwise logistic regression analysis and a Heckman two-stage model confirmed that vancomycin administration between 16 and 60 min before the first surgical incision was associated with the lowest incidence of SSI . CONCLUSIONS Vancomycin administration within 16 - 60 min before the first surgical incision reduced the risk of SSI in cardiac surgery patients
Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision .
Abstract The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis ( SAP ) on  surgical site infection ( SSI )  and compare the different timing intervals .
The benefit of routine use of SAP prior to surgery has long been recognized .
However , the optimal timing has not been defined .