Preventing postoperative infections - Current treatment recommendations

Surgical site infections (SSI) remain a major source of postoperative morbidity. The preventive effect of antimicrobial drugs on postoperative infections is without debate. The common basis of accepted indications for prophylaxis is available evidence of effect. Valid reasons to administer antimicrobial prophylaxis include a significant reduction of SSI or reducing the risk of SSI in procedures where the consequences of infection are serious or even disastrous. The antimicrobial drug must be effective against pathogens associated with infection after a given procedure. The first generation cephalosporin, cefazolin, has been considered one of the prophylactic drugs of choice in many authoritative guidelines. The optimal timing of intravenous antimicrobial prophylaxis in surgery is considered to be about 30 minutes before incision, i.e. at induction of anaesthesia. A single dose of antimicrobial drugs before the operation is sufficient prophylaxis for most surgical procedures. The development of bacterial resistance is associated with antimicrobial use, and therefore prophylactic antibiotics should be used as little as possible; in addition, the spectrum of activity of drugs used should be as narrow as possible. Although the principles of antimicrobial prophylaxis in surgery have been clearly established, many reports continue to describe inappropriate drug use. Overconsumption in terms of invalid indications or use of drugs with too broad a spectrum of activity should be eliminated by adhering to accepted guidelines. Practical suggestions are given to optimise timing, such as simple reminders on the daily operating programme, the display of prophylaxis regimens according to type of surgery in table format in the operating room and having the anaesthetist note the complete drug regimen on the patient's anaesthesia record. Such measures will help to optimise antibiotic prophylaxis and restrict if to the operating room where it belongs.