Don’t use a broad spectrum antimicrobial agent for perioperative prophylaxis or continue prophylaxis after the incision is closed for uncomplicated clean and clean-contaminated procedures.

Rationale and Comments

When indicated, the timely administration of perioperative antibiotics can reduce postoperative infections when narrow-spectrum antibiotics (e.g., cefazolin) are given before surgery. Perioperative prophylaxis should not be continued after the incision is closed for uncomplicated clean and clean-contaminated procedures (i.e., respiratory, gastrointestinal, or genitourinary sites are breached but without infection or inflammation; clean contaminated procedure is when you cross the respiratory, gastrointestinal, or urogenital tract without gross contamination.) Broad-spectrum antibiotics and longer durations of therapy have not been shown to be more beneficial, and these practices contribute to the development of antimicrobial resistance and the emergence of pathogenic organisms (e.g., Clostridium difficile). Both the dose and timing of perioperative antibiotic administration are important for optimal effect. Many studies show poor adherence to published guidelines on use of perioperative antibiotics, which emphasizes the need for ongoing quality improvement approaches in this area.

Sponsoring Organizations

American Academy of Pediatrics – Committee on Infectious Diseases and the Pediatric Infectious Diseases Society

Sources

Centers for Disease Control and Prevention

Disciplines

Infectious disease
Surgical

References

Berrios-Torres S, Umscheid C, Bratzler D, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. doi:10.1001/ jamasurg.2017.0904.
Bratzler DW, Dellinger P, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013:70:195-283.
European Centre for Disease Prevention and Control. Systematic review and evidence-based guidance on perioperative antibiotic prophylaxis. Stockholm: ECDC: 2013. Doi 10.2900/85936.
TSteinberg JP, Braun BI, Hellinger WC et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg. 2009;250: 10-6. doi: 10.1097/SLA.0b013e3181ad5fca.
Ranji Sr, Shetty K, Posley KA et al. Prevention of Healthcare-Associated Infections. Vol 6 of: Shojania KG, McDonald KM, Wachter RM, Owens DK, editors. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Technical Review 9 (Prepared by the Stanford University-UCSF Evidence-based Practice Center under Contract No. 290 02-0017). AHRQ Publication No. 04(07)-0051-6. Rockville, MD: Agency for Healthcare Research and Quality. January 2007.