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Effectiveness of antibiotic prophylaxis according to the nutritional status in patients undergoing contaminated
S Di Palo1, G Ferrari, R Castoldi
1Cattedra di Patologia Chirurgica, Università di Milano.
Abstract:
The attempt to restrict as much as possible the use of the antibiotics in surgery is related with the recent introduction of short term antibiotic prophylaxis. In this study the possibility to select among patients undergoing contaminated procedures those who can benefit more from short term antibiotic prophylaxis was considered. With this aim the nutritional status of 302 patients according to three parameters: serum albumin, total iron binding capacity and weight loss, was assessed. Results obtained from short term antibiotic prophylaxis with clindamycin and gentamicin in 149 patients (53.6% malnourished) were compared with those obtained in 153 patients (49.6% malnourished) who were not treated peroperatively. Wound infection rate in patients who received antibiotic prophylaxis was 6% versus 15% in the group which did not receive antibiotics peroperatively (p less than 0.025). A significant reduction was observed in malnourished patients while in the well-nourished the decrease was not significant. Malnourished patients seem to gain a specific benefit from antibiotic prophylaxis.
Insights
Short-term antibiotic prophylaxis in surgery benefits malnourished patients undergoing contaminated procedures. This targeted approach reduces wound infection rates in vulnerable populations, optimizing antibiotic use.
Area of Science:
- Surgical Infectious Diseases
- Clinical Nutrition
- Pharmacology
Background:
- The increasing focus on antibiotic stewardship in surgery necessitates identifying patient groups who most benefit from prophylactic antibiotics.
- Short-term antibiotic prophylaxis is a key strategy to reduce surgical site infections, but its selective application requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of short-term antibiotic prophylaxis in reducing wound infections among patients undergoing contaminated surgical procedures.
- To determine if nutritional status influences the benefit derived from antibiotic prophylaxis in this patient cohort.
Main Methods:
- Nutritional status was assessed in 302 patients using serum albumin, total iron-binding capacity, and weight loss.
- Patients undergoing contaminated procedures received either short-term antibiotic prophylaxis (clindamycin and gentamicin) or no perioperative antibiotics.
- Wound infection rates were compared between the prophylaxis and control groups, with subgroup analysis based on nutritional status.
Main Results:
- The overall wound infection rate was significantly lower in patients receiving antibiotic prophylaxis (6%) compared to those who did not (15%; p < 0.025).
- Malnourished patients demonstrated a significant reduction in wound infection rates with antibiotic prophylaxis.
- Well-nourished patients showed no significant decrease in infection rates when receiving antibiotic prophylaxis.
Conclusions:
- Short-term antibiotic prophylaxis is effective in reducing wound infections in patients undergoing contaminated procedures, particularly in malnourished individuals.
- Nutritional status is a critical factor in determining the benefit of antibiotic prophylaxis, suggesting a targeted approach for vulnerable surgical patients.
- These findings support selective antibiotic use in surgery to improve outcomes for malnourished patients while conserving antibiotic resources.