Principles of Perioperative Antibacterial Prophylaxis: Management of Surgical Site Infections.

This article reviews perioperative antibacterial prophylaxis, a discrete in-hospital intervention that prevents surgical site infections and reduces the costs of complications and adverse effects of care. Clinical trials have shown that, when used appropriately, prophylactic antibacterial agents are effective and cost effective. Appropriate use requires targeting micro-organisms that are expected to contaminate the operative field; attaining effective drug concentrations in operative site tissues at the time of bacterial contamination; using safe and inexpensive agents; and basing the choice of agents on the results of randomised trials and local patterns of drug resistance. Prophylaxis is indicated for operations in which bacterial contamination is encountered or expected. These include hysterectomy, primary Caesarean sections, Caesarean sections following prolonged rupture of the membranes, abdominal trauma and all operative procedures in which the gastrointestinal tract is opened. Gastrointestinal operations that require prophylaxis are head and neck operations in which the oropharynx is opened and procedures in which the oesophagus, stomach, duodenum, small or large intestine, appendix or biliary tract are opened. For ‘clean’ operations in which no epithelium-lined lumen is opened and no infection or gross contamination is encountered, antibacterial prophylaxis is indicated for insertion of cerebrospinal fluid shunts, prosthetic vascular grafts and orthopaedic hardware. For other ‘clean’ implant operations, such as insertion of prosthetic material in hernia repair, antibacterial prophylaxis is controversial. For ‘clean’, non-implant operations, prophylaxis is indicated for craniotomy incisions, vascular operations that use a groin incision and cardiac procedures that use a median sternotomy. For other ‘clean’, non-implant procedures, such as hernia and breast operations, antibacterial prophylaxis is used commonly, but the results from clinical trials have been equivocal. [ABSTRACT FROM AUTHOR]