From the Research
Introduction to Perioperative Antibiotic Prophylaxis
Perioperative antibiotic prophylaxis (PAP) is a crucial component in the prevention of surgical site infections (SSIs) [(1,2,3,4,5)]. The primary goal of PAP is to minimize the risk of postoperative infections, which can lead to increased morbidity, mortality, and healthcare costs.
Indications for Perioperative Antibiotic Prophylaxis
PAP is clearly indicated for operations that carry a high risk of SSI, such as colorectal surgery, and for those that involve the implantation of alloplastic material, like hip endoprostheses 1. Additionally, PAP is recommended for various surgical procedures, including solid organ transplantation 3, orthopaedic procedures 5, and cardiac procedures 5.
Principles of Perioperative Antibiotic Prophylaxis
The basic principles of PAP include:
- Administration of antibiotics by the anesthesia team 60 minutes preoperatively up to shortly before the incision 1
- Use of basic antibiotics such as cefazoline 1
- Short duration of antibiotic administration, usually as a single shot [(1,2)]
- Selection of antibiotics that are bactericidal, nontoxic, inexpensive, and active against typical pathogens 2
Antibiotic Selection and Administration
The choice of antibiotic depends on the type of surgery and patient characteristics [(4,5)]. Commonly used antibiotics in the surgical setting include:
- Cefazolin
- Clindamycin
- Vancomycin Proper dosing, targeting bacteria, and side effects should be considered when selecting an antibiotic 4.
Duration and Timing of Perioperative Antibiotic Prophylaxis
The duration of PAP should be short to decrease toxicity and antimicrobial resistance [(1,2)]. The timing of administration is crucial, with intravenous perioperative prophylaxis recommended to be administered within 30 to 60 minutes before the surgical incision 2.
Caveats and Considerations
PAP is associated with some drawbacks, including increased antibiotic resistance and development of adverse reactions 5. Therefore, it is essential to assess risks and benefits and select the most appropriate antibiotic regimen before initiating PAP 5. Additionally, individual risk factors for SSI, such as body-mass index and immunosuppression, should be assessed before any surgical procedure 1.