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Considering a new domain for antimicrobial stewardship: Topical antibiotics in the open surgical wound
Charles E Edmiston1, David Leaper2, Maureen Spencer3
1Medical College of Wisconsin, Milwaukee, WI.
Abstract:
The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.
Insights
Antimicrobial stewardship programs (ASPs) should monitor topical antibiotic use in surgical wounds. Evidence-based guidelines are needed to standardize care and consider alternatives like antiseptics.
Area of Science:
- Infectious Diseases
- Surgical Care
- Pharmacology
Background:
- Antimicrobial resistance is a global health concern.
- Antimicrobial stewardship programs (ASPs) are mandated to combat resistance.
- Topical antibiotic use in surgical wounds is often unmonitored by ASPs.
Purpose of the Study:
- To evaluate the current use of topical antibiotics in open surgical wounds.
- To assess the integration of topical antibiotic use into ASPs.
- To advocate for evidence-based standardization and consideration of alternatives.
Main Methods:
- Survey of current practices regarding topical antibiotic use.
- Analysis of existing ASP guidelines and mandates.
- Review of evidence supporting topical antibiotic efficacy and risks.
Main Results:
- Topical antibiotic use in irrigation fluids and powders during surgery is widespread.
- Current ASPs often do not monitor topical antibiotic application.
- Lack of evidence supports the routine use of topical antibiotics in this setting.
Conclusions:
- Topical antibiotic use in open surgical wounds requires monitoring within ASPs.
- Standardization of care based on evidence is necessary.
- Antiseptics represent a potential alternative to topical antibiotics.
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