Clinical References Utilizing Antibiotic Prophylaxis

Timing of antibiotic prophylaxis in elective caesarean delivery: A multi-center randomized controlled trial and meta-analysis

Zhang C, Zhang L, Liu X, Zhang L, Zeng Z, Li L, Liu G, Jiang H

"For elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up."

Surgical site infection--a population-based study in Australian adults measuring the compliance with and correct timing of appropriate antibiotic prophylaxis

Hooper TD, Hibbert PD, Hannaford NA, Jackson N, Hindmarsh DM, Gordon DL, Coiera EC, Runciman WB

"Where antibiotics were recommended, compliance was 49% for contaminated surgery, 57% for clean-contaminated surgery and 85% for surgery involving a prosthesis: these fell to 8%, 10% and 14%, respectively (an average of 11%), when currently recommended timing of antibiotic administration was included."

Impact of postoperative antibiotic prophylaxis duration on surgical site infections in autologous breast reconstruction

Drury KE, Lanier ST, Khavanin N, Hume KM, Gutowski KA, Thornton BP, Hansen NM, Murphy RX Jr, Fine NA, Kim JY

"We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction."

Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: An evidence-based consensus conference statement from the American Association of Plastic Surgeons

Ariyan S, Martin J, Lal A, Cheng D, Borah GL, Chung KC, Conly J, Havlik R, Lee WP, McGrath MH, Pribaz J, Young VL

"Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty."

A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study

Townley WA, Baluch N, Bagher S, Maass SW, O'Neill A, Zhong T, Hofer SO

"Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions."

Topically applied vancomycin powder reduces the rate of surgical site infection in diabetic patients undergoing foot and ankle surgery

Wukich DK, Dikis JW, Monaco SJ, Strannigan K, Suder NC, Rosario BL

"High-risk diabetic patients undergoing foot and ankle surgery were notably less likely to develop an SSI with the use of topically applied vancomycin powder in the surgical wound, particularly with regard to deep infections. Topically applied vancomycin was associated with a very low rate of complications and was inexpensive ($5 per 1000 mg). Based on this study, foot and ankle surgeons may consider applying 500 to 1000 mg of vancomycin powder prior to skin closure in diabetic patients who are not allergic to vancomycin."

Antibiotic prophylaxis in patients undergoing head and neck free flap reconstruction

Mitchell RM, Mendez E, Schmitt NC, Bhrany AD, Futran ND

"The choice of antibiotic appears to affect the rate of all postoperative infections and flap site infections more than the duration of antibiotics following head and neck free flap reconstruction. At our institutions, ampicillin-sulbactam is the preferred prophylactic antibiotic for major clean-contaminated head and neck procedures when possible."

Factors associated with methicillin-resistant coagulase-negative staphylococci as causing organisms in deep sternal wound infections after cardiac surgery

Sommerstein R, Kohler P, Wilhelm MJ, Kuster SP, Sax H

"Among CoNS deep sternal wound infection, perioperative antimicrobial therapy (p 0.002), early reintervention for noninfectious causes (OR 7.9; 95% CI 0.9-71.1) and time between surgery and diagnosis of infection over 21 days (OR 10.8; 95% CI 1.2-97.8) were associated with methicillin resistance. These findings may help to better tailor preoperative antimicrobial prophylaxis."

The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: A prospective randomized double-blind controlled trial

Ruangsin S, Laohawiriyakamol S, Sunpaweravong S, Mahattanobon S

"A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy. Whether or not to use a prophylactic depends on the individual patient, and the consideration of the attending surgeon."

Do we need antibiotic prophylaxis in endoscopic inguinal hernia repair? Results of the Herniamed registry

Köckerling F, Bittner R, Jacob D, Schug-Pass C, Laurenz C, Adolf D, Keller T, Stechemesser B

"The positive impact of the endoscopic/laparoscopic technique on avoidance of impaired wound healing and deep infections with mesh involvement is already so great that antibiotic prophylaxis has no additional benefit. In contrast, antibiotic prophylaxis should be administered for open inguinal hernia repair."

Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review

Huang N, Liu M, Yu P, Wu J

"Extended systemic antibiotic prophylaxis should be considered to decrease SSI risk in breast implant surgery, especially in breast reconstruction. Topical antibiotic irrigation would decrease CC risk. Risk factors such as chest irradiation and diabetes should be taken into consideration when prescribing antibiotic prophylaxis."

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Xu SG, Mao ZG, Liu BS, Zhu HH, Pan HL

"Routine antibiotic prophylaxis does not significantly decrease the rate of SSI in ORIF surgical patients with a low risk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics."

Antibiotic prophylaxis for preventing infectious complications in orthognathic surgery

Brignardello-Petersen R, Carrasco-Labra A, Araya I, Yanine N, Cordova Jara L, Villanueva J

"For people undergoing orthognathic surgery, long term antibiotic prophylaxis decreases the risk of SSI compared with short-term antibiotic prophylaxis and the is uncertainty of whether short-term antibiotic prophylaxis decreases SSi risk relative to a single pre-operative dose of prophylactic antibiotics."

One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: A randomized, controlled clinical trial

Orlando G, Manzia TM, Sorge R, Iaria G, Angelico R, Sforza D, Toti L, Peloso A, Patel T, Katari R, Zambon JP, Maida A, Salerno MP, Clemente K, Di Cocco P, De Luca L, Tariciotti L, Famulari A, Citterio F, Tisone G, Pisani F, Romagnoli J

"As the dramatic increase in antibiotic resistance has mandated the implementation of global programs to optimize the use of antibiotic agents in humans, we believe that the single dose regimen is preferred, at least in nondiabetic, non-morbidly obese, adult renal transplant recipients."

Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial

Westen EH, Kolk PR, van Velzen CL, Unkels R, Mmuni NS, Hamisi AD, Nakua RE, Vlek AL, van Beekhuizen HJ

"A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple-day regimen in preventing postcesarean wound infections in low-resource settings, therefore it can be considered as a good strategy in low-resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection."

Clinical and microbiological aspects of biofilm-associated surgical site infections

Edmiston CE Jr, McBain AJ, Roberts C, Leaper D

"The ideal method to manage a biofilm-mediated surgical site wound infection is to prevent it from occurring through rational use of antibiotic prophylaxis, adequate skin antisepsis prior to surgery and use of innovative in-situ irrigation procedures; together with antimicrobial suture technology in an effort to promote wound hygiene at the time of closure; once established, biofilm removal remains a significant clinical problem."

Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery

Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK

"Based on high quality evidence from studies whose overall risk of bias is low, intravenous prophylactic antibiotics for cesarean administered preoperatively significantly decreases the incidence of composite maternal postpartum infectious morbidity as compared with administration after cord clamp. There were no clear differences in adverse neonatal outcomes reported. Women undergoing cesarean delivery should receive antibiotic prophylaxis preoperatively to reduce maternal infectious morbidities. Further research may be needed to elucidate short- and long-term adverse effects for neonates."

Surgical site infections

Young PY, Khadaroo RG

"As guidelines for prevention of surgical site infection become increasingly complex and nuanced, surgical infection outcomes are increasing tied to quality outcome and performances measures."

Retrospective health-care associated infection surveillance in oral and maxillofacial reconstructive microsurgery

Patyi M, Sejben I, Cserni G, Sántha B, Gaál Z, Pongrácz J, Oberna F

"Our results showed that the perioperative antibiotic prophylaxis administered at our Department was efficient and effective against the oral bacterial flora of patients. Its use is recommended in head and neck microsurgery. To avoid development of antibiotic resistance and to reduce costs, it seems that the duration of antibiotic regimen for primary surgery can be reduced from 8.3 ± 5.2 days to 3 days."

A meta-analysis of spinal surgical site infection and vancomycin powder

Khan NR, Thompson CJ, DeCuypere M, Angotti JM, Kalobwe E, Muhlbauer MS, Camillo FX, Klimo P Jr

"This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection."

Skeletal muscle and plasma concentrations of cefazolin during cardiac surgery in infants

Himebauch AS, Nicolson SC, Sisko M, Moorthy G, Fuller S, Gaynor JW, Zuppa AF, Fox E, Kilbaugh TJ

"This cefazolin dosing strategy resulted in skeletal muscle concentrations that are likely not effective for surgical prophylaxis against gram-negative pathogens but are effective against methicillin-sensitive S aureus in infants undergoing cardiac surgery."

Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery

Kërveshi A, Halili N, Kastrati B, Qosja F, Kabashi S, Muçaj S

"Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only."

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Gyte GM, Dou L, Vazquez JC

"Based on the best currently available evidence, cephalosporins and penicillins have similar efficacy at caesarean section when considering immediate postoperative infections. We have no data for outcomes on the baby, nor on late infections (up to 30 days) in the mother. Clinicians need to consider bacterial resistance and women's individual circumstances."

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Smaill FM, Grivell RM

"The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is beneficial for women but there is uncertainty about the consequences for the baby."

Efficacy of intraoperative vancomycin powder use in intrathecal baclofen pump implantation procedures: Single institutional series in a high risk population

Ghobrial GM, Thakkar V, Singhal S, Oppenlander ME, Maulucci CM, Harrop JS, Jallo J, Prasad S, Saulino M, Sharan AD

"The use of vancomycin powder in patients with implants in this series did not reduce infection rates compared to published historical controls, and was elevated compared to institutional controls. Further prospective study of this high risk patient population is warranted."

Risk factors for extended spectrum ß-lactamase-producing Escherichia coli versus susceptible E. coli in surgical site infections among cancer patients in Mexico

Montes CV, Vilar-Compte D, Velazquez C, Golzarri MF, Cornejo-Juarez P, Larson EL

"The appropriate timing and duration of perioperative antimicrobial prophylaxis were associated with lower risk of ESBL E. coli in SSIs. Even though compliance to antimicrobial prophylaxis guidelines is of the utmost importance, reduced exposure to cephalosporins may also potentially decrease the risk of ESBL SSI."

Collagen implant with gentamicin sulphate reduces surgical site infection in vascular surgery: A prospective cohort study

Costa Almeida CE, Reis L, Carvalho L, Costa Almeida CM

"Collagen implant with gentamicin sulphate (Collatamp(®)) reduces SSI in the groin incision in ischaemic patients submitted to femoropopliteal PTFE prosthetic bypass. Days of hospitalization are also reduced. Decreasing SSI rate and in-hospital days, this implant may also reduce health care costs. Because this is a small pilot study, a multicentre RCT is necessary for validation."

Adherence to guidelines of antibiotic prophylactic use in surgery: A prospective cohort study in North West Bank, Palestine

Musmar SM, Ba'ba H, Owais A

"Lack of guidelines explains the low adherence to appropriate surgical antibiotic prophylaxis in Palestine, with high rate of broad spectrum antibiotic use, long duration and inappropriate time of first dose. We recommend adopting guidelines for prophylaxis and training all health care providers accordingly."

Evidence-based protocol for prophylactic antibiotics in open fractures: Improved antibiotic stewardship with no increase in infection rates

Rodriguez L, Jung HS, Goulet JA, Cicalo A, Machado-Aranda DA, Napolitano LM

"Implementation of an evidence-based protocol for open fracture antibiotic prophylaxis resulted in significantly decreased use of aminoglycoside and glycopeptide antibiotics with no increase in skin and soft tissue infection rates."

Implementing a standardized perioperative antibiotic prophylaxis protocol for neonates undergoing cardiac surgery

Murray MT, Corda R, Turcotte R, Bacha E, Saiman L, Krishnamurthy G

"Restricting the duration of perioperative antibiotic prophylaxis after neonatal cardiac surgery to 48 hours in neonates with a closed sternum and to 24 hours after sternal closure was safe and did not increase the rate of SSIs. Compliance with selected process measures improved in the postintervention period. Additional multicenter studies are needed to develop national guidelines for perioperative prophylaxis for this population."

Antibiotic prophylaxis in bariatric surgery with continuous infusion of cefazolin: Determination of concentration in adipose tissue

Anlicoara R, Ferraz ÁA, da P Coelho K, de Lima Filho JL, Siqueira LT, de Araújo JG Jr, Campos JM, Ferraz EM

"In bariatric surgeries, addition of a 1 g increase of cefazolin, administered through continuous intravenous infusion, to the currently recommended dose of 2 g administered in anesthetic induction provided a concentration in the adipose tissue above the minimum inhibitory concentration (MIC) of the main causal agents of SSI. An inverse correlation between BMI and concentration of cefazolin in adipose tissue was observed."

Efficacy of single-dose antimicrobial prophylaxis for preventing surgical site infection in radical gastrectomy for gastric carcinoma

Han JH, Jeong O, Ryu SY, Jung MR, Park YK

"Single-dose AMP showed no increase in the postoperative SSI rate compared to postoperative extended use in patients undergoing gastrectomy for gastric carcinoma. The efficacy of single-dose AMP requires further investigation in randomized clinical trials specific to gastric cancer surgery."

Perioperative antibiotics in the setting of oropharyngeal reconstruction: Less is more

Cohen LE, Finnerty BM, Golas AR, Ketner JJ, Weinstein A, Boyko T, Rohde CH, Kutler D, Spector JA

"These data suggest that extended courses of perioperative antibiotics do not confer additional benefits in patients undergoing oropharyngeal reconstruction. We recommend a limited 48-hour course of prophylactic antibiotics with sufficient aerobic and anaerobic coverage to help minimize the incidence of antibiotic-related morbidities."

Antibiotic prophylaxis and resistance in surgical site infection after immediate tissue expander reconstruction of the breast

McCullough MC, Chu CK, Duggal CS, Losken A, Carlson GW

"Administration of extended prophylactic antibiotics does not reduce overall risk of SSI after expander-based breast reconstruction but may influence antibiotic resistance patterns when infections occur. The organisms most commonly responsible for SSI are often resistant to cefazolin."

Meta-analysis of antibiotic prophylaxis in breast reduction surgery

Shortt R, Cooper MJ, Farrokhyar F, Bain J

"Preoperative antibiotics should routinely be used before breast reduction surgery. The use of postoperative antibiotics remains controversial. Additional randomized studies investigating postoperative antibiotics are needed."

Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data

Si D, Rajmokan M, Lakhan P, Marquess J, Coulter C, Paterson D

"Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease."

Antimicrobial prophylaxis for colorectal surgery

Nelson RL, Gladman E, Barbateskovic M

"This review has found high quality evidence that antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery reduce the risk of surgical wound infection. Our review shows that antibiotics delivered within this framework can reduce the risk of postoperative surgical wound infection by as much as 75%. It is not known whether oral antibiotics would still have these effects when the colon is not empty. This aspect of antibiotic dosing has not been tested. Further research is required to establish the optimal timing and duration of dosing, and the frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis."

Back to basics: Preventing surgical site infections

Spruce L

"The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives."

Intraoperative vancomycin use in spinal surgery: Single institution experience and microbial trends

Ghobrial GM, Thakkar V, Andrews E, Lang M, Chitale A, Oppenlander ME, Maulucci CM, Sharan AD, Heller J, Harrop JS, Jallo J, Prasad S

"Prophylactic intraoperative vancomycin use in the wound bed in spinal surgery may increase the incidence of gram-negative or polymicrobial spinal infections. The use of intraoperative vancomycin may correlate with postoperative seromas, due to the high incidence of nonpositive cultures. Large, randomized, prospective trials are needed to demonstrate causation and dose-response relationship."

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery

Jones DJ, Bunn F, Bell-Syer SV

"Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction."

Control strategies to prevent total hip replacement-related infections: A systematic review and mixed treatment comparison

Zheng H, Barnett AG, Merollini K, Sutton A, Cooper N, Berendt T, Wilson J, Graves N

"We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs."

Antimicrobial prophylaxis in tonsillectomy: The efficacy of preoperative single-dose oral administration of azithromycin in preventing surgical site infection

Otake H, Suga K, Suzuki H, Nakada T, Kato K, Yoshida T, Teranishi M, Sone M, Nakashima T

"The results indicate that oral administration of azithromycin (AZM) is equivalent to intravenous administration of cefazolin (CEZ) for preventing surgical site infection (SSI) in patients undergoing tonsillectomy, and should be used as cost-effective antimicrobial prophylaxis."

[Surgical site infections: Antibiotic prophylaxis in surgery]

Asensio A

"For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost."

Research Studies Utilizing Antibiotic Prophylaxis