Monitoring of Antimicrobial Prophylaxis in General Surgery

Abstract

The incidence of infections in general surgery is related to different factors. Cost-benefit analysis of antimicrobic prophylaxis is positive, even though incorrect use may be even dangerous (development of resistance and/or superinfections, for instance). The authors report data on a study concerning a total of 316 patients divided into two series, who had antimicrobic prophylaxis before a surgical operation. 274 patients out of 316 (or 86.7%) had an ultra-short (one-shot-only) or short (<24 hours) prophylaxis, 42 (13.3%) standard (>24 hours). The operations performed were classified following class of contamination, i.e. I (clean), II (potentially contaminated), III (contaminated). Antibiotics used were ceftizoxime, cefepime, ceftriaxone, piperacillin and gentamicin in combination. A total of 16 postoperative infections was observed (5%); 11 of these 16 belonged to class III operations. Escherichia coli and Staphylococcus aureus were isolated in most of the infected wounds. The data confirm what is reported in the literature. The authors conclude that a preoperative single-shot 3rd or 4th generation cephalosporin reduces the incidence of wound infections in clean and clean-contaminated surgery.

Evaluation of Antimicrobial Usage in Dogs and Cats at a Veterinary Teaching Hospital in Germany in 2017 and 2018

“…The range of active ingredients prescribed overall is also similar to the range of active ingredients used for single preoperative injections in dogs and cats in 2017 and 2018, respectively. The prophylactic use of AMs may exert a positive effect on the frequency of surgical site infections in humans (30)(31)(32) and animals (33)(34)(35), but the time between the injection and first incision is crucial (35,36). In general, apart from perioperative AMUs, guidelines have been established to reduce the systemic administration of AMs (37,38).…”

Pharmacokinetics of cefepime in bile and gall bladder tissue after prophylactic administration in patients with extrahepatic biliary diseases

“…Cefepime, which achieved high concentrations in all tissues assayed at the time of surgery with twice-daily dosing [14], has been successfully used for surgical prophylaxis in biliary tract interventions [15,16].…”