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

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.