Surgery antimicrobial prophylaxis

Discuss the importance of timing, duration, and redosing in relation to antimicrobial prophylaxis in surgery. 

Discuss the possible impact of antibiotic-impregnated bone cement and how this affects the use of antimicrobial prophylaxis in surgery. 

From Kanji S, Devlin JW. Antimicrobial prophylaxis in surgery. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 2219, with permission.)... 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 1999 56 1839-1888. 

Bratzler DW, Houck PM, for the Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005 189 395-404. 

Gorbach SL Antimicrobial prophylaxis for appendectomy and colorectal surgery. Rev Infect Dis 1991 13(suppl 10) S815-S820. 

Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther 2001 43 92-98. 

Song F, Glenny AM Antimicrobial prophylaxis in colorectal surgery A systematic review of randomized controlled trials. Br J Surg 1998 ... 

Strategies for Implementing an Institutional Program to Ensure the Appropriate Use of Antimicrobial Prophylaxis in Surgery... 

See Chap. 127, Antimicrobial Prophylaxis in Surgery, authored by Salmaan Kanji and John W. Devlin, for a more detailed discussion of this topic. 

Surgical procedures that necessitate the use of antimicrobial prophylaxis include contaminated and clean-contaminated operations, selected operations in which postoperative infection may be catastrophic such as open heart surgery, clean procedures that involve placement of prosthetic materials, and any procedure in an immunocompromised host. The operation should carry a significant risk of postoperative site infection or cause significant bacterial contamination. 

Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 2006 4 83. 

---