From the Guidelines
The primary treatment for superficial surgical infections involves opening the incision, evacuating the infected material, and continuing dressing changes until the wound heals by secondary intention, with antibiotics only considered for patients with significant systemic signs of infection or extensive erythema. When treating superficial surgical infections, it is essential to prioritize wound care and only use antibiotics when necessary, as supported by the Infectious Diseases Society of America's 2014 guidelines 1. The guidelines suggest that if there is less than 5 cm of erythema and induration, and if the patient has minimal systemic signs of infection, antibiotics are unnecessary. Some key points to consider when treating superficial surgical infections include:
- Opening the incision and evacuating the infected material to promote drainage and healing
- Continuing dressing changes until the wound heals by secondary intention
- Using antibiotics only for patients with temperature >38.5°C or heart rate >110 beats/minute or erythema extending beyond the wound margins for >5 cm
- Choosing empiric antibiotics based on the site of surgery and potential flora, such as mixed gram-positive and gram-negative flora for operations on the intestinal tract or female genitalia
- Considering a short course (eg, 24–48 hours) of antibiotics for patients with significant systemic signs of infection. It is crucial to note that the treatment of superficial surgical infections should be tailored to the individual patient's needs, taking into account the severity of the infection, the presence of systemic signs, and the potential for antibiotic resistance, as highlighted in the guidelines 1.
From the FDA Drug Label
Skin and Skin Structure Infections: Due to S. aureus (penicillin-sensitive and penicillin-resistant), group A beta-hemolytic streptococci, and other strains of streptococci. The recommended dose for mild infections caused by susceptible gram-positive cocci is 250 mg to 500 mg every 8 hours and for moderate to severe infections is 500 mg to 1 gram every 6 to 8 hours 2.
- Superficial surgical infections can be considered as skin and skin structure infections.
- The choice of dose and frequency should be based on the severity of the infection.
- It is essential to note that cefazolin for injection is the recommended form of administration, not PO (oral), as indicated in the provided drug labels.
From the Research
Treatment of Superficial Surgical Infection
- The treatment of superficial surgical site infections (SSIs) can be managed with antibiotics alone, especially when promptly diagnosed 3.
- A study found that antibiotics resolved the superficial SSI in 70% of patients, and did not resolve the SSI in 30% of patients 3.
- Factors associated with persistent infection despite superficial SSI antibiotic treatment include:
- Superficial SSIs diagnosed later in follow-up 3.
- The primary treatment of SSI encompasses liberal debridement of the wound 4.
- Management of SSI includes consistent antibiotic therapy, wound drainage, and rigorous wound debridement as appropriate 5.
- Novel antiinfectives such as avibactam and dalbavancin may be alternatives to existing treatment, but should be used only on the ground of susceptibility testing and if standard drugs are inappropriate 5.
Prevention and Risk Factors
- Risk factors for SSI include anemia, immunosuppression, diabetes mellitus, obesity, smoking, and malnutrition 4.
- Preoperative preventive measures include antisepsis of the surgical area and antibiotic prophylaxis 4.
- Intraoperative subcutaneous wound irrigation with an antiseptic solution reduces SSI in visceral surgery 4.
Consensus and Future Directions
- A consensus among experts from five European countries found that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay 6.
- There was strong positive consensus on the cost-effectiveness of early discharge programs, improvement of quality of life with early discharge, and association between increased length of stay and economic burden to the hospital 6.
- Reducing the length of hospital stays by applying early discharge protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital 6.