Surgical antimicrobial prophylaxis: Current standards of care

Abstract

SummaryAntimicrobial drug resistance is a critical problem in human and veterinary medicine. Antimicrobial drug use and particularly overuse or misuse drive resistance. Surgical antimicrobial prophylaxis (SAP) is one area where misuse and overuse (particularly prolonged SAP) is documented to be at a high level. Infection‐related complications can be devastating to the patient, harm the client/patient–surgeon relationship and damage the reputation of the surgeon. Consequently, surgeons tend to be reluctant to change their antimicrobial prescribing behaviour. There is a plethora of data from human surgery and emerging data from veterinary surgery describing appropriate SAP and supporting the use of shorter duration of SAP. Antimicrobial stewardship programs (ASPs) have been developed and evaluated in human hospitals and this type of collaborative approach would likely have benefit in veterinary hospitals.

The Effects of Antimicrobial Protocols and Other Perioperative Factors on Postoperative Complications in Horses Undergoing Celiotomy: A Retrospective Analysis, 2008–2021

“…Current standards of care in equine veterinary surgical antimicrobial prophylaxis (SAP) were recently reviewed by Southwood et al [25]. Resistant microbial infections have resulted in more than 1.2 million human deaths worldwide in 2019 [26].…”

“…Furthermore, antimicrobial drug resistance is not only a concern in the human medical field, but reports in equine veterinary medicine exist describing multidrug resistant infections with Staphylococcus, Escherichia coli, and Enterococci, as well as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, and rifampin-and macrolide-resistant Rhodococcus equi [28][29][30][31][32][33][34][35][36][37][38]. The impact of antimicrobial resistance on equine practice specifically, challenges to appropriate use, and the opportunity to improve clinical outcomes through responsible antimicrobial use, including in critical patients, has been emphasized in several pertinent recent review articles [25,[39][40][41][42][43][44][45]. Factors contributing to appropriate antimicrobial use, such as indication for administration, selection, dosing, timing, route, duration, modification, and therapy have been reviewed recently by Hardefeldt et al [46].…”

“…Factors contributing to appropriate antimicrobial use, such as indication for administration, selection, dosing, timing, route, duration, modification, and therapy have been reviewed recently by Hardefeldt et al [46]. Emerging data generally support a shorter duration of SAP and encourage further development of collaborative antimicrobial stewardship programs within institutions [25]. Findings of this study are in concordance with this work, indicating that antimicrobial type or timing (pre-, intra-, or postoperative) were not associated with decreased risk of incisional infection or postoperative ileus, and that additional doses of antimicrobials did not affect complication rate.…”

“…While clinical practice guidelines for SAP for human surgical patients have been well defined by the Surgical Infection Society, Infectious Disease Society of America, American Society of Health-System Pharmacists, and Society for Healthcare Epidemiology of America [47], there are fewer studies in equine surgery [25]. When compared to musculoskeletal procedures such as arthroscopy, exploratory celiotomy in horses tends to have a higher complication and infection rate [55].…”

Review of the role of biofilms in equine wounds: Clinical indications and treatment strategies

“…Acquisition of certain chromosomal mutations can also compromise antimicrobial susceptibility of bacterial biofilms (Ciofu et al, 2017). Antimicrobial drug resistance is a critical issue in veterinary and human medicine, with a body of emerging data supporting shorter duration of antimicrobial prophylaxis and greater consideration for the development of antimicrobial stewardship programmes (Southwood, 2023). In general, BBWC While appropriate to treat planktonic infections in acute wounds and/or immediately following debridement, the benefit of systemic antibiotics to treat biofilms remains controversial.…”