Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial

Abstract

Swiss National Science Foundation, Hospital of Aarau, University of Basel, Gottfried und Julia Bangerter-Rhyner Foundation, Hippocrate Foundation, and Nora van Meeuwen-Häfliger Foundation.

Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections

“…The cut-off of 1 hour was chosen based on current guidelines concerning the optimal timing for SAP and was further explored in sensitivity analyses. (5, 23, 24)…”

Clinical Issues—February 2019

“…The organization should form an interdisciplinary team of key stakeholders to design a standardized process for integrating the current guidelines into established workflows (Table ). According to researchers and clinical practice guidelines, the best timing for prophylactic antibiotic administration is unclear . However, most researchers agree that the antibiotic administration should be complete at the time of incision, and that a range of up to 120 minutes for some antibiotics with longer infusion times before incision is acceptable .…”

“…According to researchers and clinical practice guidelines, the best timing for prophylactic antibiotic administration is unclear . However, most researchers agree that the antibiotic administration should be complete at the time of incision, and that a range of up to 120 minutes for some antibiotics with longer infusion times before incision is acceptable . The Centers for Disease Control and Prevention recommends administration of preoperative antimicrobial agents only when indicated, and that they be timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made.…”

“…Ultimately, optimal preoperative prophylactic antibiotic administration is based on a theoretical principle: the peak of antibiotic concentration at the surgical site should be reached at the time of incision . For this reason, antibiotic administration timing depends on the necessary infusion time and the pharmacokinetics of each antibiotic for each individual patient . Implementing a standardized organizational process that applies to all patients makes this level of individualization extremely difficult and perhaps unnecessary if research continues to support the current recommended range as found in clinical practice guidelines.…”

Antimicrobial prophylaxis is critical for preventing surgical site infection

“…In a randomized clinical trial, Weber et al administered 1.5 g of cefuroxime early (30-75 min before scheduled incision) in the anesthesia room or late in the operating room (0-30 min before scheduled incision) to 5,580 patients who were followed for a 30-day duration (5). The antibiotic was given 42 min before incision in the early group and 16 min before incision in the late group.…”