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Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle.

Massimo Sartelli1, Federico Coccolini2, Francesco M Labricciosa3

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This review presents a surgical antibiotic prophylaxis (SAP) bundle to prevent surgical site infections (SSIs). The evidence-based bundle includes five measures for correct SAP administration, promoting safety and collaboration in hospitals worldwide.

Keywords:
bundlehealthcare-associated infectionspreventionsurgical antibiotic prophylaxissurgical site infections

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Area of Science:

  • Infection Prevention and Control
  • Surgical Safety
  • Antimicrobial Stewardship

Background:

  • Healthcare-associated infections, particularly surgical site infections (SSIs), pose a significant clinical challenge.
  • Surgical antibiotic prophylaxis (SAP) is a critical measure for preventing SSIs.
  • Existing guidelines require adaptation for local implementation and routine clinical care.

Purpose of the Study:

  • To present a comprehensive bundle for correct surgical antibiotic prophylaxis (SAP) administration.
  • To evaluate the evidence supporting the proposed SAP bundle for SSI prevention.
  • To facilitate the transfer of best practices in SAP into routine clinical care.

Main Methods:

  • Narrative review of international guidelines (WHO, CDC, NICE, SHEA/IDSA/APIC/AHA, ASHP/IDSA/SIS/SHEA) for SSI prevention and SAP.
  • Comprehensive literature searches in PubMed®/MEDLINE and Google Scholar for supporting evidence.
  • Identification and synthesis of key interventions for optimal SAP administration.

Main Results:

  • A five-measure bundle for SAP administration was developed, applicable globally.
  • Key recommendations include appropriate patient selection, timing (within 60 min pre-incision), redosing criteria, and discontinuation post-procedure.
  • The bundle is based on pharmacokinetic/pharmacodynamic principles and emphasizes an interdisciplinary approach.

Conclusions:

  • The proposed SAP bundle provides an evidence-based, easily implementable strategy for preventing SSIs.
  • It promotes antimicrobial stewardship and supports the development of an institutional safety culture.
  • The bundle encourages collaboration and can be effectively monitored in all healthcare settings worldwide.