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Volume 7, Number 5—October 2001
Research

Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery

Giorgio Zanetti*†Comments to Author , Sue J. Goldie‡, and Richard Platt*§
Author affiliations: *Channing Laboratory, Brigham and Women's Hospital, and Eastern Massachusetts CDC Prevention Epicenter, Boston, Massachusetts, USA; †University Hospital, Lausanne, Switzerland; ‡Harvard School of Public Health, Boston, Massachusetts, USA; §Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA

Main Article

Table 1

Model variablesa

Variables Base case Plausible range References
Incidence of SSI
  Superficial 0.08 0.02 – 0.12 (12,17)
  Deep 0.04 0.01 – 0.06 (12,17)
Causative organisms: (12,13)
  Staphylococcus aureus 0.25 0.20 – 0.35
  Coagulase-negative Staphylococci 0.25 0.20 - 0.35
  Enterococci 0.05 0.02 - 0.15
  Gram-negative bacteria 0.30 0.15 – 0.50
Relative risk of SSI caused by susceptible organisms
  Vancomycin vs. no prophylaxis 0.4 0.20 – 0.80 (18-23)
  Cefazolin vs. no prophylaxis 0.4 0.20 – 0.80 (18-23)
Incidence of antibiotic-related adverse events
  Vancomycin 0.08 0.01 – 0.20 (24)
  Cefazolin 0.08 0.01 – 0.20 (24,25)
Incidence of SSI due to resistant organisms (26)
  MRSA (% of all SSI due to S. aureus) 0.012 0 – 0.03
(0.40)
  Methicillin-resistant CNS (% of all 0.024 0 – 0.03
  SSI due to CNS) (0.80)
  VRE (% of all SSI due to enterococci) 0.003 0 - 0.006
(0.15)
  Incidence of SSI caused by cefazolin-susceptible Gram-negative bacteria (% of all SSI due to gram-negative bacteria) 0.01 (0.28) 0 – 0.036
History of allergy to beta-lactams 0.1 0.05 – 0.15 (27)
Probability of hospital death
  Deep surgical site infection 0.082 0.01 – 0.10 (12)
  Antibiotic allergic reaction 0.00002 (28)
  Coronary artery bypass graft surgery-related events 0.036 0.01 – 0.1 (29)
Costs per case (US$)
  Vancomycin 80 60 – 250 (24)
  Cefazolin 24 10 – 50 (24)
  Superficial SSI 8,000 3000 – 15,000 (30,31)
  Deep SSI 36,800 10,000 – 50,000 (30,31)
  Vancomycin-related adverse event 107 20 – 1,000 (24)
  Cefazolin-related adverse event 107 20 – 1,000 (24)
  Death 5,900 0 – 10,000 (32)
  Multiplication factor for infections due to methicillin-resistant organisms
1.13
0.9 - 2
(33)
  Multiplication factor for infections due to VRE 1.5 0.9 - 3 b

aSSI = surgical site infection; MRSA = methicillin-resistant Staphylococcus aureus; CNS = coagulase-negative staphylococci; VRE: vancomycin-resistant enterococci.
bWe assumed that the cost of an infection caused by a vancomycin-resistant enterococcus was 50% greater than the cost of a comparable infection caused by a susceptible strain.

Main Article

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Page updated: April 26, 2012
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