Perioperative antibiotic prophylaxis: Current recommendations

Perioperative antibiotic prophylaxis (PAP) leads to a reduction in surgical site infections following many operating procedures. Thousands of clinical studies and numerous meta-analyses conducted over the past three decades have proved the efficacy of PAP in a broad range of surgical interventions. There is a substantial difference in the incidence of surgical site infections between clean, clean contaminated, contaminated and dirty operations, which had first been classified by Cruse in 1980. The relative risk of wound infections varies substantially over different levels of surgery cleanliness. However, there are a lot of different risk factors which can influence the rate of wound infections. The statistically proven risk factors can be divided into preoperative, intraoperative and postoperative risk factors. Preoperative risk factors are emergency operations, patients post radiation, recurrent operations and patients with foreign materials. The relevant intraoperative risk factors comprise long lasting operations, low oxygen and low qualification of the surgeon. Low temperature, respiratory insufficiency and multiple abdominal drains are typical postoperative risk factors. The indication for PAP should take into account the risks of the operative procedure and especially the individual risk factors of the patient. Depending on the pharmacodynamic properties of the chosen drug the antibiotic should be administered within about 30 min before incision. After closure of the wound, further applications of the antibiotic drug have no influence on the infection rate of the wound. This observation was confirmed by several metaanalyses and key publications. The antibiotic must be safe and effective against the expected pathogens during the operation and have the fewest possible side effects. Among the different antibiotic substance classes the ß-lactam antibiotics are the therapeutic drugs of choice. These drugs are preferred due to their bactericide abilities, known pharmacokinetics and few potential side effects. Continuous development during the past decade has made the third-generation cephalosporins the drugs of choice in abdominal surgery. © 2012 Euromed Communications Ltd.