Antibiotic prophylaxis

Abstract

Surgical site infection (SSI) is a common postoperative complication which leads to significant morbidity and mortality. The aim of antibiotic prophylaxis is to reduce the incidence of SSI by preventing the development of infection due to colonizing or contaminating organisms at the operative site. It is used as an adjunct to, rather than a replacement for, other evidence-based interventions to prevent wound infection, such as the use of skin antiseptics. The choice of antimicrobial agent(s) used is dependent on how clean the operation is, the operative site (which determines the likely organisms), and a variety of patient factors including the presence of allergies and colonization with resistant organisms such as meticillin-resistant Staphylococcus aureus (MRSA). The practicalities of antibiotic prophylaxis administration are discussed. Not all operations require antibiotic prophylaxis; use of antibiotics in any context, including as prophylaxis, can be associated with adverse effects, specifically an increased risk of Clostridium difficile infection (CDI) and resistance development. Prophylaxis should therefore be used responsibly. This article will address some of the common misconceptions about its use and special patient circumstances requiring deviation from the usual guidance.

What’s New in Infection on Surgical Site and Antibioticoprophylaxis in Surgery?

“…It should not be used routinely in clean operations, unless they involve the placement of prostheses or implants. Antibiotic prophylaxis should not be used in infected operations, as in this circumstance, effective treatment with antibiotics should be prescribed 17 , 20 , 21 .…”

“…Thus, gram-positive cocci present on the skin, for example Staphylococcus aureus and Staphylococcus coagulase negative are the most common agents in clean operations, and gram-negative and anaerobic bacteria are present in SSIs after potentially contaminated or contaminated procedures. Generally, low-cost antimicrobial agents with bactericidal properties, narrow spectrum of action, good tissue penetration and covering the pathogens most involved in that particular procedure should be used for antibiotic prophylaxis, in accordance with the recommendations of the hospital infection control committee of that institution 4 , 11 , 17 , 20 .…”

“…In elective operations, this must occur at least two weeks before the operation. In emergency cases, immunizations should ideally be administered two weeks after surgery, when physiological recovery occurs 4 , 11 , 17 , 20 .…”

“…The surgical site infection (SSI) appears in a wound created by a surgical or post-operative procedure of any cavity, bone, joint, tissue or prosthesis involved. The organisms involved are generally endogenous to the patient and come from the skin or any viscera that has been opened 20 . It is the most common postoperative complication, with significant morbidity and mortality, and represents 17% of healthcare-related infections.…”

Evaluation of Antibiotics Use and Bacteria Profile of Caesarean Section at Regional General Hospital, Pasuruan

“…Antibiotik profilaksis diberikan kepada pasien dengan tujuan untuk mengurangi jumlah bakteri yang ada dan membantu pertahanan alami dari host sehingga infeksi dapat dicegah. 7 Penggunaan antibiotik profilaksis perioperatif yang adekuat dapat mengurangi laju angka kejadian ILO hingga mencapai 50%. 8 Selain itu, penggunaan antibiotik yang sesuai dapat membantu mengurangi kejadian resistensi terhadap antibiotik.…”