Surgical Antimicrobial Prophylaxis: Principles and Guidelines

Abstract

Antimicrobial prophylaxis for surgical procedures is an area that is recognized as being subject to individual clinical variations. This review gives practitioners some basic principles of rational prophylaxis as defined by the medical literature. In addition, this literature is evaluated and condensed to provide clinicians with guidelines for particular procedures: obstetric, gynecologic, gastric, biliary, colonic, urologic, cardiac, thoracic, vascular, orthopedic and head and neck. Each section concludes with recommendations for the clinically most accepted prophylactic regimens. Antibiotics discussed include not only the older agents, but where good information exists, the newer cephalosporins. The suggested regimens consider efficacy, safety and cost as determinants in rational prescribing. Although research into even shorter, and perhaps more cost-effective, regimens continues, this compilation lists state-of-the-art recommendations.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…Infection after vascular procedures occurs with low frequency but can be associated with extensive morbidity and mortality. 867,868 Postoperative infections involving vascular graft material can result in limb loss and life-threatening conditions. 868 As a result, antimicrobial prophylaxis is widely used in procedures that involve implantation of prosthetic material and procedures for which there is greater risk of infection, such as aneurysm repair, thromboendarterectomy, and vein bypass.…”

The Microbiology and Risk of Infection Following Open, Agricultural Upper Extremity Injuries

“…14,15 In the 1960s, however, studies in orthopedic surgery and general surgery clearly demonstrated improved outcomes when patients were treated with antibiotics prior to surgery. 16,17 The issue remains a controversial one with respect to orthopedic trauma. 18 Regardless of etiology, antibiotic prophylaxis for open fractures is not nationally standardized.…”

The Role of Prophylactic Antibiotics in Elective Hand Surgery

“…Multiple studies have shown that use of prophylactic antibiotics decreases infection rates and shortens hospital stay in contaminated and clean contaminated surgical procedures. 2 Boyd et al 3 4 demonstrated in prospective, randomized, double-blind, placebo-controlled studies that use of perioperative antibiotics in the surgical treatment of hip fractures reduced the rate of postoperative infection. Gatell et al demonstrated a statistically significant decrease (p Ͻ .05) in the incidence of superficial wound infections of patients who had placement of an Ender or Kuntscher nail, bone plate, or other internal fixation device when preoperative and postoperative antibiotics were used.…”