From the Research
Antibiotic prophylaxis is generally recommended for percutaneous tracheostomy procedures to reduce the risk of surgical site infections. A single dose of a first-generation cephalosporin such as cefazolin 2g IV should be administered within 60 minutes before the procedure, as supported by the most recent study 1. For patients with beta-lactam allergies, alternatives include clindamycin 600-900mg IV or vancomycin 15mg/kg IV (for MRSA-colonized patients) 2. The rationale for prophylaxis is that tracheostomy creates a direct communication between the airway and external environment, introducing potential pathogens into a normally sterile space. The procedure involves penetration of the tracheal mucosa, which is colonized with bacteria, particularly in patients who have been intubated for prolonged periods. Prophylactic antibiotics target common skin flora and respiratory pathogens to prevent local wound infections and more serious complications like mediastinitis or necrotizing soft tissue infections. Some studies suggest that antibiotic prophylaxis may reduce the rate of wound infection after tracheostomy, although the evidence is not yet conclusive 3, 4. However, given the potential benefits and the low risk of adverse effects, antibiotic prophylaxis is recommended for percutaneous tracheostomy procedures. For patients already on antibiotics for other indications, additional prophylaxis may not be necessary if their current regimen provides adequate coverage against the expected pathogens. It is essential to note that the choice of antibiotic and the duration of prophylaxis should be individualized based on the patient's specific needs and risk factors, as well as local antimicrobial resistance patterns. Percutaneous tracheostomy is a common procedure that can be safely performed with appropriate planning and precautions, including the use of ultrasound and bronchoscopy to minimize complications 5. Overall, the use of antibiotic prophylaxis for percutaneous tracheostomy procedures is a crucial aspect of reducing the risk of surgical site infections and improving patient outcomes.