Antimicrobial prophylaxis in the surgical patient

Postoperative infection is a major cause of operative morbidity and mortality. The primary prophylactic measure against postoperative infection is antiseptic surgical technique; however, antimicrobial prophylaxis has been demonstrated to be of greater benefit than harm in some procedures. Because the data are limited, extrapolating these findings to the individual patient remains a challenge. Endocarditis is one of the most serious postoperative infections. Although the great majority of endocarditis cases are not attributable to invasive procedures, some surgical and dental procedures can produce transient bacteremia. Therefore, antimicrobials are administered to at-risk patients undergoing these procedures with the goal of reducing the occurrence of procedure-related endocarditis. This article summarizes recommendations for antimicrobial prophylaxis against wound infections in the surgical patient, and the recommendations of the American Heart Association panel of experts for antimicrobial prophylaxis of endocarditis.