Perioperative Antibiotic Prophylaxis of Wound and Foreign Body Infections: Microbial Factors Affecting Efficacy

Abstract

Numerous microbial factors are responsible for perioperative infections and influence the efficacy of antibiotic prophylaxis. These factors include the staphylococcal carrier state, bacterial adherence to a number of host proteins, the production of glycocalyx by sessile bacteria, and shifts in antibiotic resistance. A full understanding of the mechanisms involved will lead to further reductions in the number of postoperative infections. Unfortunately, the microbial factors affecting prophylaxis cannot be evaluated separately under clinical conditions; they are easier to study under circumstances whose bacteriologic features are well defined and in which the presence offoreign materials (e.g., sutures) greatly potentiates pathogenic mechanisms. Such circumstances exist, for example, in infections developing after "clean" surgery and in experimental models. Since even clean wounds are found to be contaminated when sampled carefully, the control of infection is more a quantitative than a qualitative problem. The critical period for the development of infection is short: an antibiotic course not exceeding 24 hours seems effectivein preventing infection.Wounds produced by surgical intervention, their spontaneoushealing,their complications (including infections), and methods to accelerate their closure havebeen described for thousandsof years. The use of sutures, for example, is clearly depicted in the Smithpapyrus, which datesback to 4000 B.C. [1]. Postoperative infectionevidently has always been a feared complication of surgical procedures, and many techniques and devices have been developed throughout history to prevent such infection. Withthe advent of antibiotics, it wasbelieved that the prevalence of this type of infection would decrease drastically. This was not the case. For instance, in a study on herniorrhaphy between. 1937 and 1957, the incidence of postoperativeinfection hoveredsteadilyaround4 %[2]. Over the past 15 years, however, considerable workhas shownthe benefitof shortcoursesof antimicrobial agents for the prevention of infection in a widevarietyof surgical procedures [3][4][5].The factthat skinincision, organmanipulation,or the consequences thereof increase the incidence of local infection points toward alteration of local host factors influencing microbial elimination. Demonstrations of the efficacy of antimicrobial agents are indicative of the impact of bacterial factors on the postsurgical evolution of wounds. The role of bacterial factors is further underscored by the clear demonstrationthat prophylacticantibioticsare effective in contaminatedand clean-contaminated surgery, whereas their efficacy is more controversial in clean surgery-a situation in which the bacterial load is very low and therefore more difficultto evaluate.It hasbecomealmostaxiomatic to categorize surgical proceduresas clean, clean-contaniinated, contaminated,and purulent. Each category probably has common as well as specific risks and pathogenicfactors [1]. Each also has its owntypical group of pathogenic organisms, among ...

Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center

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Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia

“…As the rare deep infection results in a low risk of mesh removal (between 0·09 per cent 28 and 1·1 per cent 20 ), and a remarkably low rate of hernia recurrence, there remains no indication for routine antibiotic prophylaxis in low-risk patients 29 . Avoiding antibiotic prophylaxis could reduce the risk of toxic and allergic side-effects, the possible development of bacterial resistance 14 and reduces costs.…”

“…Reduction in the number of wound infections would impact on patient satisfaction, sick leave and wound care. Conversely, avoiding antibiotic prophylaxis could reduce the risks of toxic and allergic side-effects, the possible development of bacterial resistance 14 and minimize costs. A systematic review and, where possible, a meta-analysis of randomized controlled trials (RCTs) was carried out to determine whether antibiotic prophylaxis prevents wound infection after mesh hernia repair.…”

Local Delivery of Vancomycin for the Prophylaxis of Prosthetic Device-Related Infections

“…Prosthetic device-related infections are difficult to treat because bacteria associated with prosthetic implants form a biofilm that coats the device and dwells beneath as a colony, a highly networked unit of cells that resists host immune response and renders administered antibiotics ineffective (5). A biofilm is defined as an assemblage of microbial cells that is both enclosed by an extracellular polysaccharide containing polymer matrix and attached to a surface by means of glycocalyx (6,7).…”