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[Antimicrobial prophylaxis in surgery]
José Miguel Cisneros1, Jesús Rodríguez-Baño, José Mensa
1Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain. jcisnerosh@medynet.com
Abstract:
Antimicrobial prophylaxis in surgery refers to a very brief course of an antimicrobial agent initiated just before the start of the procedure. The efficacy of antimicrobials to prevent postoperative infection at the site of surgery (incisional superficial, incisional deep, or organ/space infection) has been demonstrated for many surgical procedures. Nevertheless, the majority of studies centering on the quality of preoperative prophylaxis have found that a high percentage of the antimicrobials used are inappropriate for this purpose. This work discusses the scientific basis for antimicrobial prophylaxis, provides general recommendations for its correct use and specific recommendations for various types of surgery. The guidelines for surgical antimicrobial prophylaxis are based on results from well-designed studies, whenever possible. These guidelines are focussed on reducing the incidence of infection at the surgical site while minimizing the contribution of preoperative administration of antimicrobials to the development of bacterial resistance.
Insights
Antimicrobial prophylaxis, a brief pre-surgery antimicrobial course, is effective but often misused. This guide provides evidence-based recommendations for appropriate use to prevent surgical site infections and minimize bacterial resistance.
Area of Science:
- Infectious Diseases
- Surgical Sciences
- Pharmacology
Context:
- Surgical antimicrobial prophylaxis involves administering antimicrobial agents shortly before surgical procedures.
- While proven effective in preventing surgical site infections (SSIs), current practices show high rates of inappropriate antimicrobial selection and administration.
- This highlights a critical gap between the established efficacy of prophylaxis and its real-world application.
Purpose:
- To discuss the scientific rationale underpinning antimicrobial prophylaxis in surgery.
- To provide evidence-based general and specific recommendations for the appropriate use of antimicrobials in various surgical contexts.
- To reduce the incidence of SSIs while mitigating the emergence of antimicrobial resistance.
Summary:
- Antimicrobial prophylaxis is crucial for preventing postoperative infections, yet studies reveal frequent inappropriate use of agents.
- This work details the scientific basis for prophylaxis and offers guidelines for correct application across different surgical procedures.
- Recommendations prioritize reducing SSIs and curbing the development of bacterial resistance.
Impact:
- Improved patient outcomes through effective prevention of surgical site infections.
- Reduced healthcare costs associated with treating postoperative infections.
- Stewardship of antimicrobial agents to combat the growing threat of bacterial resistance.