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Guidelines on Antibiotic Prophylaxis in Surgery 2024
Marc Garnier1, Rémy Gauzit2, Marc Léone3
1Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France. iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France; GRC29, DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France.
Objective:
To provide guidelines for antibiotic prophylaxis in surgery and interventional medicine.
Design:
A consensus committee of 167 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and 28 surgery and interventional medicine learned societies was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.
Methods:
The latest SFAR guidelines on antibiotic prophylaxis in surgery and interventional medicine were published in 2018. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate antibiotic prophylaxis in surgery and interventional medicine. The experts studied questions within 2 fields and 9 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology.
Results:
The experts' synthesis work and the application of the GRADE® method resulted in 9 tables of recommendations dealing, by specialty, on antibiotic prophylaxis in surgery and interventional medicine. Among the formalised recommendations, several have high levels of evidence (GRADE 1+) and low levels of evidence (GRADE 2+). For many recommendations, the GRADE method could not be applied, resulting in expert opinions. After 2 rounds of scoring and amendment, strong agreement was reached for all the recommendations.
Conclusions:
There was strong agreement among experts for all the recommendations to improve practices for antibiotic prophylaxis in surgery and interventional medicine.
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