The Appropriate Use of Antibiotics in Surgery A Review of Surgical Infections.pdfVIP

The Appropriate Use of Antibiotics in Surgery: A Review of Surgical Infections Surgical Site Prophylaxis Introduction Surgical site infections (SSI) are the most common infections acquired by surgical patients, accounting for up to 40% of all health care-associated infections in the surgical population.1,2 Surgical site infections are a leading cause of perioperative morbidity and mortality and contribute substantially to already rising health care costs. Since their inception in the 1960s, prophylactic antibiotics have arguably had the single greatest effect on the development of SSIs since the introduction of aseptic technique. However, the widespread abuse of prophylactic antibiotics, which can account for up to 50% of an institution’s antimicrobial prescriptions,3 has led to detrimental changes in hospital flora and resistance patterns worldwide. Multiple evidenced-based guidelines re- garding the proper use of antibiotic prophylaxis are available. Yet the inappropriate use of prophylactic antibiotics remains common practice within the surgical community.1,4 Although many factors specific to each operation dictate practice, the most important concepts that apply to the general use of the prophylactic agent are spectrum of coverage and timing of adminis- tration.5 The prophylactic agent should target the most likely offend- ing organisms specific to the operative site. Surgical site infections associated with most clean cases are commonly the result of Gram- positive cocci such as S. aureus and coagulase-negative staphylococci; clean-contaminated SSIs may also involve Gram-negative and anaer- obic microorganisms. As a result, first generation cephalosporins are appropriate prophylactic agents for clean cases, whereas second gen- e