1102. Ertapenem vs. Nonertapenem Antibiotics in Colorectal Surgery: A Stewardship Opportunity

BACKGROUND: The optimal regimen for antibiotic prophylaxis in colorectal surgery is not well defined. The aim of this study was to determine whether nonertapenem antibiotic prophylaxis in colorectal surgery is associated with increased rates of surgical site infections (SSI), defined by both deep and incisional infections, compared with ertapenem prophylaxis. Secondary aims were to identify differences in C. difficile infection rates at 60 days between the two groups. METHODS: This was a single-center retrospective study from November 2016 to December 2018 at a 600-bed teaching hospital equipped with a Level I Trauma Center in Central Texas. National Healthcare Safety Network (NHSN) criteria for colorectal surgical site infection (SSI) were used to identify eligible patients. Patients under 18 years or lacking pre-operative antibiotic documentation were excluded. SSI and C. difficile rates between the two prophylactic strategies were compared using Chi-squared and Fisher’s exact tests as appropriate. RESULTS: A total of 761 patients were included in the analysis. There were 87 patients in the ertapenem group and 674 patients in the nonertapenem group. Antibiotics included in the nonertapenem group were cefazolin (32%), ceftriaxone (22%), or ciprofloxacin (15%) plus metronidazole, and other antibiotics (31%). Baseline characteristics including age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and number of surgical procedures were similar for both groups. The overall SSI rate was 4.7% and the 60-day C. difficile rate was 3.9%. No significant differences were found between ertapenem and nonertapenem groups in SSI rates (5.8% vs. 4.6%, P = 0.6) or 60-day incidence of C. difficile (6.9% vs. 3.6%, P = 0.1). CONCLUSION: Our study, with a large sample size and a low overall incidence of SSI, did not find a significant difference in either SSI rates or 60-day C. difficile rates between ertapenem and nonertapenem prophylaxis in colorectal surgery. Given the rise of Gram-negative resistance, this study highlights an important opportunity for carbapenem stewardship. DISCLOSURES: All authors: No reported disclosures.