Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens

Abstract

Bariatric surgery for obesity has emerged as an effective and commonly used treatment modality. This paper reviews the surgical site infections (SSIs) that occur post bariatric surgery and SSI prevention. The benefit of bariatric surgery resulting in profound weight loss brings with it consequences in the form of postoperative complications that can have profound effects on morbidity and mortality in these patients. This paper sets out to define different types of SSIs that occur following bariatric surgery and to discuss existing literature on the critical aspects of SSI prevention and the appropriate use of surgical antimicrobial prophylaxis for bariatric surgery.

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review

“…A long term strategy is required for its prevention and it must be managed with a comprehensive approach 1 . Obesity is associated to increase mortality and morbidity 1,4 , and this condition is frequently not controlled by diet and pharmacologic therapy. Bariatric surgery, however, is being shown to be more effective in sustained weight reduction 5 which increases the demand for surgical intervention in these patients 6 .…”

“…Although obesity is considered a risk factor for nosocomial infections 4,7 particularly surgical site infection (SSI), there were few studies that have evaluated this specific factor among patients submitted to bariatric surgery 7,8 . It is considered one of the most common complications in bariatric surgery 5,9 , and its magnitude may be underestimated 5 .…”

“…It is considered one of the most common complications in bariatric surgery 5,9 , and its magnitude may be underestimated 5 . The frequency of SSI in obese patients ranges from 1-21.7% after bariatric surgeries 4,5,7,10,11 , depending on the surgical technique applied 7 . It is important to consider that in these studies there is a poor standardization of antibiotic agents and its posology.…”

“…First generation cephalosporin's, due to spectrum, safety and experience of use, are the choice in the prophylaxis of most of surgeries 4 . A recent guideline issued by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Surgical Infection Society and the Society for Health Care Epidemiology of America recommends cefazolin for procedures involving entry into lumen of gastrointestinal tract (as in bariatric surgery), with strength of evidence "A" 13 .…”

“…A recent guideline issued by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Surgical Infection Society and the Society for Health Care Epidemiology of America recommends cefazolin for procedures involving entry into lumen of gastrointestinal tract (as in bariatric surgery), with strength of evidence "A" 13 . This drug is, indeed, widely employed 4,5,8,11,14,15 .…”