Surgical antibiotic prophylaxis (SAP) is not a method of tissue sterilization, but a precisely timed measure to decrease the microbial load of intraoperative contamination to a level that does not overwhelm the host immune defence. It also does not refer to prevention of Surgical Site Infections (SSIs) following postoperative contamination. The scope of SAP is oriented around elective operations in which skin incisions are closed in the operation room [1]. In light of this, the indications are basically clean and clean-contaminated elective surgical procedures. Recommendations issued in clinical practice guidelines likewise, apply to elective surgery. The World Health Organization (WHO) Guidelines for Safe Surgery has one of its objectives as the prevention of SSIs, through the use of SAP and decontamination of the gastrointestinal tract [2].SSIs are the most common complication following surgery. Patients undergoing clean-contaminated procedures have incidences of 11% for colonic resections [3], and 3-27% for rectal procedures [4]. Careful follow up of patients in clinical trials reveals rates that are considerably higher [5]. Other septic complications, like enterocutaneous fistulae, complicated intra-abdominal infections, and septicemia, are serious but are much less common. Infectious complication rates range from 30% to 60% without SAP [6], and are <10% with it.These infections cause delayed wound healing and treatment, time lost from work and, occasionally, death. For health-care institutions, they are a major contributor to increased costs owing to longer hospital stays, readmissions and additional use of antibiotics that can lead to bacterial antibiotic-resistance. They fit the description of being a major player in patient injury, mortality, and health care costs. Patients who experience SSIs are up to 60% more likely to spend time in the Intensive Care Unit (ICU), 5 times more likely to be readmitted to hospital and twice as likely to die compared with patients without a SSI [7].
Meta-analyses demonstrate that antibiotic prophylaxis is the most
Antibiotic Prophylaxis in Colorectal Surgery: Evolving Trends
AbstractIntroduction: Surgical antibiotic prophylaxis has become standard practice for patients undergoing colorectal surgery. This clinical practice has changed greatly over the last three decades, and it is currently accepted worldwide. It is phenomenal in minimizing postoperative wound infection in elective surgery. Clinical practice guidelines have been developed to herald this. However, the practice is yet to be established in some regions, particularly lowincome countries. A review of the evolution of the practice is necessary.Clinical Overview: Being a clean-contaminated procedure, colorectal surgery is a typical indication for antibiotic prophylaxis. The antibiotic for use is chosen on the basis of -its activity against endogenous flora likely to be encountered, its toxicity, and its cost, in that order. Controversy persists concerning the route of administration (oral, intravenous, or both),...