Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery

Abstract

Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.

Abdominal Actinomycotic Abscess after Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Report

“…According to Massimo et al [ 21 ], the use of prophylactic antibiotics in relation to obesity varies depending on whether they are hydrophilic or lipophilic. For cephazolin, high doses are unnecessary, and given as a single 2 g IV bolus 3–5 min before skin incision maintains protective cefazolin concentration for 4.8 h. In this patient’s case, 2 g of cephazolin was administered just before the skin incision, and the surgery lasted for 2.5 h, making the prophylactic antibiotic use appropriate.…”

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

“…Surgical antibiotic prophylaxis (SAP) is a crucial component of perioperative infection prevention [ 148 , 149 ], particularly in clean-contaminated and contaminated surgical procedures with a high infection risk. SAP may also be indicated in certain clean procedures where SSI, even if unlikely, may have devastating consequences, such as procedures with prosthetic implants.…”

“…The most common antibiotics used for SAP have been first- and second-generation cephalosporins (e.g., cefazolin, cefuroxime) [ 148 , 149 ]. Cefazolin is the drug of choice for SAP before most procedures.…”

“…For most frequently used antibiotics, such as cefazolin or cefoxitin, intravenous administration 30–60 min before incision ensures effective tissue concentrations at the time of incision [ 168 ]. Redosing during surgery is required when the operative procedure lasts for more than 4 h or there is > 1.5 L blood loss [ 149 , 169 ]. Vancomycin should be administered within 120 min before the incision, and given over 1 h for a 1 g dose (longer, if the dose is higher).…”

Ten golden rules for optimal antibiotic use in hospitals: based on the publication statement of the International Network Group of the World Antimicrobial Resistance

“…Depending on the flora of the mucous membranes on which the incision is made, clean and contaminated procedures may involve other bacteria such as E. coli, other Enterobacterales or anaerobes. The most common antibiotics used for SAP have been firstand second-generation cephalosporins (e.g., cefazolin, cefuroxime) [148,149]. Cefazolin is the drug of choice for SAP before most procedures.…”