Timing and Choice of Antibiotic Prophylaxis for Prevention of Surgical Site Infections: A Systemic Review

Abstract

BACKGROUND: Surgical site infection (SSI) doubles the mortality, cost, hospital stay and the rate of ICU admission in post operative patients. Parenteral antibiotic administration in the perioperative period is one of the effective strategies for prevention of SSI. However, the practice around administration of antibiotics in this setting is often not standardized, depending mainly on surgeon's preference. OBJECTIVE: We set out to clarify the timing of antibiotic for prophylaxis in surgery and the most appropriate antibiotic choice. METHODS: The study was a systematic review of literature on the subject within the last 5 years. Literature was retrieved from "Google Scholar", "Pubmed" and "Medline". Those that met the eligibility criteria were included and analyzed. RESULTS: The reviewed literature indicated that antibiotic prophylaxis should be administered within 60 minutes before surgical incision and should not be continued beyond 24 to 48 hours. The choice should be guided by local susceptibility patterns, but cefazolin or cefuroxime or ampicillin-sulbactam are used in most settings. Metronidazole should be added when anaerobic organisms are expected. CONCLUSIONS AND RECOMMENDATION: We recommend a review of guidelines or institution of guidelines where none exists, to reinforce the timing and choice of antibiotic for pre-operative prophylaxis.