JUDICIOUS USE OF ANTIBIOTICS IN SURGERY Judicious use of antimicrobials is an integral part of good clinical practice This attitude may maximize the utility and therapeutic efficacy of treatment, and minimize the risks associated with emerging infections (such as C. difficile) and the selection of antimicrobial resistance.
ANTIBIOTIC PROPHYLAXIS •
Antibiotics are unable to prevent surgical site infections alone. Strategies to prevent surgical site infections should always include attention to: - infection control strategies - surgical technique - hospital and operating room environments - instrument sterilization processes - perioperative optimization of patient risk factors - appropriate management of surgical wounds
•
Antibiotic prophylaxis should be administered for operative procedures that have a high rate of postoperative wound infection, or when foreign materials is implanted
•
Antibiotic prophylaxis should be active against the pathogens most likely to contaminate the surgical site
•
Broad-spectrum antibiotics should be always avoided
•
Antibiotic prophylaxis should be administered not more than 30 to 60 minutes before surgery giving an appropriate dosage that ensures adequate serum and tissue concentrations during the period of potential contamination
•
Additional antibiotic doses should be administered intraoperatively for prolonged procedures
•
Antibiotic prophylaxis administered for the shortest effective period to minimize adverse effects, the development of resistance and the risk for C. difficile infection
ANTIBIOTIC THERAPY •
Antimicrobials should be used after a treatable surgical infection has been recognized or if there is a high degree of suspicion of an infection
•
The source of infection should be always investigated and controlled as soon as possible
•
Empiric antimicrobial therapy should be started in patients with surgical infection because microbiological data (culture and susceptibility results) can require up to 48-72 hours before they are available for a targeted therapy
•
Knowledge of local rates of resistance should be always an essential component in choice of the empiric antimicrobial regimen
•
For patients with community-acquired infections, empiric agents with a narrower spectrum of activity should be administered
•
For patients with hospital-acquired infections, antimicrobial regimens with broader spectra of activity should be administered
•
Targeted antimicrobial therapy regimens should be adapted when antimicrobial susceptibility test results are available
•
The antimicrobial therapy should be shortened in patients having no signs of on-going infection
•
Patients having signs of sepsis beyond 5 to 7 days of antibiotic treatment should undergo diagnostic investigation to determine an ongoing infection
Antimicrobial resistance is widespread worldwide. Clinicians should be aware of their role and responsibility for maintaining the effectiveness of current and future antimicrobials. Health workers can help tackle resistance by: enhancing infection prevention and control, prescribing and dispensing the right antimicrobial(s) to treat the illness when they are truly needed.
www.infectionsinsurgery.org