Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?

Area of Science:

• Surgical Infection Prevention
• Peripheral Vascular Surgery
• Antibiotic Prophylaxis

Background:

• Surgical site infections (SSIs) are a significant complication in peripheral vascular surgery.
• The efficacy of prophylactic antibiotics and optimal administration routes in reducing SSIs remain areas of investigation.

Purpose of the Study:

• To evaluate the effectiveness of prophylactic antibiotics in reducing incisional infections in peripheral vascular surgery.
• To determine if the route of antibiotic administration (topical, intravenous, or combined) impacts infection rates.

Main Methods:

• A prospective, randomized, blinded study involving patients undergoing vascular procedures with groin incisions.
• Four groups were established: no antibiotic, topical cephradine, 24-hour intravenous cephradine, and combined topical and intravenous cephradine.
• Incisional infections were monitored and compared across the four groups.

Main Results:

• Prophylactic antibiotics, regardless of administration route (topical, intravenous, or combined), significantly reduced groin and abdominal incisional infections (p < 0.01).
• No significant differences in infection reduction were observed among the three antibiotic treatment groups.
• Specific procedures like profundoplasty, femoral embolectomy, and femoral aneurysm repair were associated with a higher risk of infection (p < 0.01).
• Other identified risk factors were only significant in patients not receiving prophylactic antibiotics.

Conclusions:

• Both intraoperative topical antibiotics and perioperative systemic antibiotics are effective in preventing infections in peripheral vascular surgery.
• Administering antibiotics via both topical and intravenous routes concurrently offers no additional benefit over single-route administration.
• Optimizing antibiotic prophylaxis can reduce surgical site infections and associated complications in vascular procedures.