Perioperative surgical prophylaxis in the era of multidrug-resistant gram-negatives
Christian Eckmann1, Nana-Maria Wagner2
1Department of General, Visceral and Thoracic Surgery, Academic Hospital of Goettingen University, Klinikum Hannoversch-Muenden.
Purpose Of Review:
To present the current knowledge and recent developments regarding intravenous perioperative antibiotic prophylaxis (PAP) for patients undergoing abdominal surgery who are colonized with multidrug-resistant gram-negative bacteria (MDR-GN).
Recent Findings:
Surgical site infections (SSIs) are a frequent cause of postoperative morbidity and mortality in abdominal surgery. PAP is one of the key measures to reduce SSI rates. The number of patients colonized with MDR-GN is increasing globally. Recent evidence indicates that the combination of risk-adapted screening and targeted prophylaxis in patients being colonized with MDR-GN and undergoing elective abdominal surgery can substantially decrease SSI rates. Preoperative decolonization procedures have not been shown to be effective so far.
Summary:
In cases of proven MDR-GN colonization, targeted prophylaxis reduces postoperative SSI rates in abdominal surgery. Further clinical research is necessary to more accurately define the risk collectives for MDR-GN colonization in order to optimize screening procedures and effectiveness of targeted prophylaxis. Furthermore, clinical research is needed to evaluate the effectiveness of innovative decolonization procedures and specific antibiotics to be used for targeted PAP in patients colonized with carbapenem-resistant bacteria.
Insights
Targeted perioperative antibiotic prophylaxis (PAP) significantly reduces surgical site infections (SSIs) in abdominal surgery patients colonized with multidrug-resistant gram-negative bacteria (MDR-GN). Risk-adapted screening and targeted PAP are key to improving outcomes.
Area of Science:
- Infectious Diseases
- Surgical Oncology
- Pharmacology
Background:
- Surgical site infections (SSIs) are a major cause of morbidity and mortality following abdominal surgery.
- The prevalence of patients colonized with multidrug-resistant gram-negative bacteria (MDR-GN) is increasing globally.
- Perioperative antibiotic prophylaxis (PAP) is crucial for reducing SSI rates.
Purpose of the Study:
- To review current knowledge on intravenous perioperative antibiotic prophylaxis (PAP).
- To discuss recent developments in managing MDR-GN colonized patients undergoing abdominal surgery.
- To highlight strategies for preventing SSIs in this high-risk population.
Main Methods:
- Review of current literature and recent evidence on PAP for MDR-GN colonized patients.
- Analysis of the effectiveness of screening and targeted prophylaxis strategies.
- Evaluation of decolonization procedures and antibiotic choices.
Main Results:
- Risk-adapted screening combined with targeted PAP can substantially decrease SSI rates in MDR-GN colonized patients undergoing elective abdominal surgery.
- Current preoperative decolonization procedures have not demonstrated effectiveness.
- Targeted prophylaxis in cases of proven MDR-GN colonization is effective in reducing postoperative SSIs.
Conclusions:
- Targeted prophylaxis is effective in reducing postoperative SSIs in abdominal surgery patients with proven MDR-GN colonization.
- Further research is needed to optimize screening for MDR-GN colonization and refine targeted prophylaxis strategies.
- Investigating innovative decolonization methods and specific antibiotics for carbapenem-resistant bacteria is essential.
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