The Prophylactic Use of Antibiotics in Surgery

The Prophylactic Use of Antibiotics in Surgery Hellenic Journal of Surgery (2018) 90:2, 61 EDITORIAL Voros DC Almost 50 years have passed since the publication of which has far-reaching negative implications for both the the now historic studies by Polk (1969), Nichols (1973), treated patient and others that are or will be hospitalized Stone (1976) and Condon (1979) [1-4], on the efficacy of in the same hospital. perioperative antibiotic use for the prevention of surgical Unfortunately, the aforementioned principles are not site infections (SSIs, infections of the operative incision always followed in practice, as surgeons may inappropri- and/or operative space) in elective surgery. Subsequent ately employ advanced, broad spectrum antibiotics and/or reports by the same authors, as well as by other surgeons administer multiple antibiotic doses for the prevention of and infectious disease specialists, largely confirmed the SSIs. These practices likely stem from misplaced anxiety original findings, thus rendering perioperative antibiotic with respect to the outcome of the operation or from an use an integral part of the contemporary standard of care, erroneous belief that liberal antibiotic use may prevent the as described in clinical practice guidelines published by development of complications, which is far from the case. multiple scientific societies, national and international Inappropriate antibiotic use not only offers no immedi- health organizations [5,6]. ate benefit to the patient, but, as discussed above, it also The principal message of the aforementioned studies decreases the therapeutic options available in the case of was, and continues to be, that while appropriate skin an- postoperative infection and contributes to the emergence tisepsis and good operative technique (particularly with of resistant microorganisms in the hospital environment. respect to limiting tissue damage and hematoma formation It is known that antibiotics are the only drugs with the and avoiding the use of non-functioning drains) are impor- potential to affect not only the patient receiving them, but tant in preventing SSIs, the perioperative use of antibiotics also both present and future hospitalized patients. As such, can reduce the incidence of such infectious complications surgeons should always keep in mind that clinical judgement still further. In order to optimize outcomes, it is critical should be firmly grounded on evidence, and that the duty that antibiotic use for this indication should adhere to the to provide the best possible care to current patients does following general principles: a) antibiotic(s) should be not provide justification for compromising the outcome administered intravenously just before the operation and of future patients. As is often the case in medicine, when it a repeat dose should be given only during certain lengthy comes to the prophylaxis of SSIs, less is more. and complex operations, b) the specific antibiotic(s) used should be tailored to the flora of the operated organ, the flora of the skin (when prosthetic materials are used) and References the flora of the nosocomial environment, following consul- tation with the infection control committee of the hospital, 1. Polk HC, Lopez-Mayor JF. Postoperative wound infection: c) provided that the aforementioned ‘target’ flora are c ov- A prospective study of determinant factors and prevention. ered, the antimicrobial spectrum of the antibiotic(s) used Surgery 1969;66:97-103. 2. Nichols RL, Broido P, Condon RE, et al. Effect of preopera- must be as narrow as possible, d) advanced, broad spectrum tive neomycin-erythromycin intestinal preparation on the antibiotics should be reserved solely for therapeutic use, incidence of infectious complications following colon surgery. in the event that an infection develops after surgery. This Ann Surg 1973;178:453. principle not only ensures that a ‘second line of defense’ 3. Stone HH, Hooper AC, Kolb LD, et al. Antibiotic proph- against postoperative infection is maintained, but also ylaxis in gastric, biliary and colonic surgery. Ann Surg helps to arrest the extension of antimicrobial resistance, 1976;184Q:443-50. 4. Condon RE, Bartlett JG, Nichols RL, et al. Ochi S Pre-operative prophylactic cephalothin fails to control septic complications of colorectal operations: Results of a controlled clinical trial. Voros DC Am J Surg 1979;137:68-74. Emeritus Professor of Surgery, University of Athens 5. Pang Y Young, Rachel G Khadaroo. Surgical Site Infections, Surgical Clinics of North America 2014;94:1245-64. Corresponding author: Voros C Dionysios 6. Gilbert DN, Champers HF, Eliopoulos GM, et al. The San- Emeritus Professor of Surgery, University of Athens e-mail: diovoros@med.uoa.gr, d.voros@dunant.gr ford Guide to Antimicrobial Therapy 2015. 45th ed; 2015. Hellenic Journal of Surgery 90 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Hellenic Journal of Surgery Springer Journals

The Prophylactic Use of Antibiotics in Surgery

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Hellenic Surgical Society and Springer-Verlag GmbH Austria, part of Springer Nature
Subject
Medicine & Public Health; Surgery
ISSN
0018-0092
eISSN
1868-8845
D.O.I.
10.1007/s13126-018-0439-1
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Abstract

Hellenic Journal of Surgery (2018) 90:2, 61 EDITORIAL Voros DC Almost 50 years have passed since the publication of which has far-reaching negative implications for both the the now historic studies by Polk (1969), Nichols (1973), treated patient and others that are or will be hospitalized Stone (1976) and Condon (1979) [1-4], on the efficacy of in the same hospital. perioperative antibiotic use for the prevention of surgical Unfortunately, the aforementioned principles are not site infections (SSIs, infections of the operative incision always followed in practice, as surgeons may inappropri- and/or operative space) in elective surgery. Subsequent ately employ advanced, broad spectrum antibiotics and/or reports by the same authors, as well as by other surgeons administer multiple antibiotic doses for the prevention of and infectious disease specialists, largely confirmed the SSIs. These practices likely stem from misplaced anxiety original findings, thus rendering perioperative antibiotic with respect to the outcome of the operation or from an use an integral part of the contemporary standard of care, erroneous belief that liberal antibiotic use may prevent the as described in clinical practice guidelines published by development of complications, which is far from the case. multiple scientific societies, national and international Inappropriate antibiotic use not only offers no immedi- health organizations [5,6]. ate benefit to the patient, but, as discussed above, it also The principal message of the aforementioned studies decreases the therapeutic options available in the case of was, and continues to be, that while appropriate skin an- postoperative infection and contributes to the emergence tisepsis and good operative technique (particularly with of resistant microorganisms in the hospital environment. respect to limiting tissue damage and hematoma formation It is known that antibiotics are the only drugs with the and avoiding the use of non-functioning drains) are impor- potential to affect not only the patient receiving them, but tant in preventing SSIs, the perioperative use of antibiotics also both present and future hospitalized patients. As such, can reduce the incidence of such infectious complications surgeons should always keep in mind that clinical judgement still further. In order to optimize outcomes, it is critical should be firmly grounded on evidence, and that the duty that antibiotic use for this indication should adhere to the to provide the best possible care to current patients does following general principles: a) antibiotic(s) should be not provide justification for compromising the outcome administered intravenously just before the operation and of future patients. As is often the case in medicine, when it a repeat dose should be given only during certain lengthy comes to the prophylaxis of SSIs, less is more. and complex operations, b) the specific antibiotic(s) used should be tailored to the flora of the operated organ, the flora of the skin (when prosthetic materials are used) and References the flora of the nosocomial environment, following consul- tation with the infection control committee of the hospital, 1. Polk HC, Lopez-Mayor JF. Postoperative wound infection: c) provided that the aforementioned ‘target’ flora are c ov- A prospective study of determinant factors and prevention. ered, the antimicrobial spectrum of the antibiotic(s) used Surgery 1969;66:97-103. 2. Nichols RL, Broido P, Condon RE, et al. Effect of preopera- must be as narrow as possible, d) advanced, broad spectrum tive neomycin-erythromycin intestinal preparation on the antibiotics should be reserved solely for therapeutic use, incidence of infectious complications following colon surgery. in the event that an infection develops after surgery. This Ann Surg 1973;178:453. principle not only ensures that a ‘second line of defense’ 3. Stone HH, Hooper AC, Kolb LD, et al. Antibiotic proph- against postoperative infection is maintained, but also ylaxis in gastric, biliary and colonic surgery. Ann Surg helps to arrest the extension of antimicrobial resistance, 1976;184Q:443-50. 4. Condon RE, Bartlett JG, Nichols RL, et al. Ochi S Pre-operative prophylactic cephalothin fails to control septic complications of colorectal operations: Results of a controlled clinical trial. Voros DC Am J Surg 1979;137:68-74. Emeritus Professor of Surgery, University of Athens 5. Pang Y Young, Rachel G Khadaroo. Surgical Site Infections, Surgical Clinics of North America 2014;94:1245-64. Corresponding author: Voros C Dionysios 6. Gilbert DN, Champers HF, Eliopoulos GM, et al. The San- Emeritus Professor of Surgery, University of Athens e-mail: diovoros@med.uoa.gr, d.voros@dunant.gr ford Guide to Antimicrobial Therapy 2015. 45th ed; 2015. Hellenic Journal of Surgery 90

Journal

Hellenic Journal of SurgerySpringer Journals

Published: Jun 4, 2018

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