[Perioperative antibiotic prophylaxis-The new German S3 guideline]

Antimicrobial stewardship (AMS) is a relatively new movement in Germany that aims to rationalize the use of antibiotics. The primary aim is to halt the global rise of bacterial resistance which of course also affects Germany. Perioperative antibiotic prophylaxis is an important topic for AMS. In December 2024 the new S3 guideline on perioperative prophylaxis was published by the Association of the Scientific Medical Societies in Germany (AWMF), which are also presented here.Surgical site infections (SSI) have greatly increased in Germany in recent years. These should be prevented with perioperative antibiotic prophylaxis. Nevertheless, for AMS reasons, the antibiotic prescription of perioperative prophylaxis should be judicious. As many studies have shown, the optimal time for administering antibiotics is 30-60 min before the surgical incision. This interval ensures an adequate antibiotic concentration in skin and subcutaneous tissue. A history of penicillin allergy should be preoperatively questioned as only a small proportion of patients who report a penicillin allergy actually have one; however, beta-lactams are the most important substances for perioperative prophylaxis, alternative substances such as clindamycin are less effective and resistance rates have greatly increased. Multidrug-resistant pathogens (MRE) are now given special consideration: the new guideline lists surgical procedures where MRE should be considered as well as the recommended screening and adjustment of substance selection in this situation. The most important point from the perspective of infectious diseases, however, is the duration of the perioperative antibiotic prophylaxis: it is specified also in the new guidelines (with a few exceptions) as a single dose (plus intraoperative re-dosing in the event of a long duration of surgery or high intraoperative blood loss).The new guidelines excellently summarize the existing data and based on these provide clear recommendations. It thus supports AMS efforts in this area in an exemplary manner.