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1243. Continuous vs. Intermittent Intraoperative Infusion of Cefazolin on Surgical Site Infections (SSIs) and Acute Kidney Injury in Patients Undergoing Cardiac Procedures

Abstract Background Continuous infusion cefazolin (CI) has been investigated as a means to optimize antibiotic exposure for prophylaxis against SSI, notably in patients undergoing cardiac procedures involving cardiac bypass (CPB). However, data are limited on its impact on late SSIs and adverse events. In 6/16, the Duke University Hospital (DUH) Antimicrobial Stewardship Team implemented a program to promote CI. We compared the incidence of culture-confirmed SSIs through postoperative day 90 (POD90) between patients receiving either intermittent infusion cefazolin (INT) or CI intraoperatively. We also compared the rate of acute kidney injury (AKI) between groups. Methods This retrospective quasi-experimental design included adult and pediatric patients undergoing cardiac surgery at DUH between March 2014 and August 2018 and receiving intraoperative cefazolin (alone or in combination with other antibiotics). Patients were categorized as CI (having received at least 1 intraoperative CI infusion) or INT. Culture-confirmed SSIs utilizing NHSN definitions were recorded and a relative risk (RR) determined. AKI was defined as a ≥0.3 mg/dL rise in serum creatinine within 2 days postoperatively. Results A total of 2,172 unique surgical procedures (from 2,143 unique patients) were included. Comparisons of groups are summarized in Table 1. Rates of SSIs were 1.1% and 1.6% in the CI and INT groups, respectively (RR [95% confidence interval] for CI 0.73, [0.35, 1.52]). AKI was reported in 12.9% and 17.4% of patients, respectively. Conclusion We were unable to detect a difference in late SSIs between intraoperative CI and INT cefazolin. Differences observed between AKI between groups requires further investigation, but likely impacted by confounders, including pre-existing renal dysfunction. Disclosures All authors: No reported disclosures.

Background. Post-operative wound care can be an important strategy to prevent surgical site infection (SSI) following craniotomy. Insufficient wound care, blood clots, and oily hair near the incision can increase SSI risk.

Methods.
We conducted a pre-post prospective cohort evaluation of a quality improvement intervention to address inpatient post-operative craniotomy wounds at an academic hospital. A post-op wound care protocol was jointly developed by neurosurgical wound care nurses, clinicians, and infection preventionists. The protocol began on postoperative day 1, and included use of soft ties to keep adjacent hair away from the incision, use of 2% CHG cloths to clean skin and hair within 2 inches of the incision as well as the proximal 6 inches of any surgical drain, and use of 2% CHG cloths to remove blood clots. Selection of 2% CHG cloths for blood clot removal was made following comparison to several concentrations of peroxide. A twice-weekly photo-survey of all inpatients undergoing craniotomy was undertaken during the baseline period (October-December 2018) and intervention period (March-April 2019), with feedback to wound care nurses occurring during the intervention period only. The proportion of redness, extensive blood clots (>50% incision), and oily hair near the incision were compared between the baseline period and the intervention period using Fisher's exact tests.
Results. A total of 156 photo assessments were performed in 71 patients (101 assessments in 45 patients in the baseline period, and 55 photo assessments in 26 patients in the intervention period). Demographics, body mass index, emergent status, and prior craniotomy were similar across the baseline and intervention periods. The intervention was associated with significant reductions in redness (27.7% vs. 11%, P = 0.015), blood clots (33.7% vs. 10.9%, P = 0.002), and oily hair near the incision (76.7% vs. 28.6%, P < 0.001) (Figure 1).
Conclusion. The care of post-operative craniotomy wounds and adjacent hair was significantly improved through a standardized protocol to remove blood clots and ensure clean skin and hair adjacent to the incision during the post-operative inpatient stay. Photo documentation and feedback to wound care nurses helped ensure protocol adherence.

Disclosures. All authors:
No reported disclosures. Background. THA is one of the most commonly performed surgeries for pathologic diseases of the hip. Multiple risk factors have been identified for SSI including: female gender, previous joint surgery, hematoma, joint dislocation, intraarticular glucocorticoid injection, rheumatoid arthritis, uncontrolled diabetes, anemia, malnutrition, and an immunosuppressed state. The objective of our study is to evaluate obesity (body mass index (BMI) >30) as an independent risk factor for THA SSI and identify other risk factors for SSI Methods. A retrospective case-control (1:3) matched observation study was conducted from January 1, 2014-June 30, 2016. Patients with a THA SSI were identified using NHSN definitions and 3 controls were matched for sex and month of surgery for each SSI case. Patient information was extracted through chart review including BMI, revision surgery, chronic kidney disease (CKD), diabetes mellitus (DM), anemia, malnutrition, smoking, surgery duration, steroid use, pre-operative chlorhexidine (CHG) bathing and nasal povidone-iodine (PI) compliance. Multivariate analysis using a conditional logistic regression model was performed.

Evaluation of Risk Factors for Development of Total Hip Arthroplasty (THA) Surgical Site Infections (SSI)
Results. Among 906 THA, 29 patients developed an SSI with 87 matched patients over the 2.5 years. The mean age in the SSI group was 61.0 years, and 37.9% were male. Mean age in the control group was 63.1, and 40.1% were male. In both groups, the most common indications for surgery were osteoarthritis followed by osteonecrosis and malignancy. Results of multivariate analysis identified five independent risk factors for SSI (see Table 1).
Conclusion. Obesity (BMI >30) was identified as an independent risk factor for THA SSI as well as CKD, steroid use and revision arthroplasty. While these risk factors are not easily modifiable, noncompliance with pre-operative CHG bathing and PI administration were also identified as significant SSI risk factor. These findings emphasize the importance of evaluating patients for SSI risk factors including obesity and improving compliance with all pre-operative SSI reduction measures.