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Monitoring of antimicrobial prophylaxis in general surgery
S Colizza1, A Picconi, G Blasi
1Divisione di Chirurgia Generale, AfaR, CRCCS, Fatebenefratelli-Isola Tiberina, Roma, Italy.
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.
Insights
A single preoperative dose of 3rd or 4th generation cephalosporin significantly reduces surgical wound infections in clean and clean-contaminated procedures. This approach is effective and aligns with cost-benefit analyses of antimicrobial prophylaxis.
Area of Science:
- General Surgery
- Infectious Diseases
- Pharmacology
Background:
- Surgical site infections (SSIs) are a significant concern in general surgery, influenced by various factors.
- Antimicrobial prophylaxis is crucial but requires careful administration to prevent resistance and superinfections.
- Cost-benefit analyses support appropriate antimicrobial prophylaxis in surgical settings.
Purpose of the Study:
- To evaluate the efficacy of preoperative antimicrobial prophylaxis in reducing postoperative infection rates.
- To compare the outcomes of different durations of antimicrobial prophylaxis.
- To identify key factors influencing the incidence of surgical site infections.
Main Methods:
- A study involving 316 patients undergoing general surgery was conducted.
- Patients received either ultra-short/short (<24 hours) or standard (>24 hours) antimicrobial prophylaxis.
- Operations were classified by contamination class (I, II, III), and antibiotics like ceftizoxime, cefepime, ceftriaxone, piperacillin, and gentamicin were used.
Main Results:
- A total of 16 postoperative infections (5%) were observed across all patients.
- The majority of infections (11 out of 16) occurred in Class III (contaminated) operations.
- Escherichia coli and Staphylococcus aureus were the most common pathogens isolated from infected wounds.
Conclusions:
- Preoperative single-shot prophylaxis with 3rd or 4th generation cephalosporins is effective in minimizing wound infections.
- This strategy is particularly beneficial for clean and clean-contaminated surgical procedures.
- The findings support the judicious use of antimicrobial prophylaxis to improve surgical outcomes.