Introduction to surgical antibiotic prophylaxis
One-third to one-half of antibiotic use in hospitals is for surgical antibiotic prophylaxis (the use of antibiotics to prevent postoperative infection). Inappropriate prescribing of surgical antimicrobial prophylaxis remains high, especially with respect to timing and duration.
Principles for appropriate prescribing of surgical antibiotic prophylaxis are outlined in Principles for appropriate prescribing of surgical antibiotic prophylaxis (below). For discussion of the role of prophylaxis, including the recommended regimens, for specific procedures, see Surgical antibiotic prophylaxis for specific procedures.
- Do not use surgical antibiotic prophylaxis unless there is a clear indication for its use (see Indications for surgical antibiotic prophylaxis and the recommendations for specific procedures).
- Antibiotic choice may need to be modified according to patient factors, including the presence of infection, recent antimicrobial use, colonisation with multidrug-resistant bacteria, prolonged hospitalisation or the presence of prostheses. See Antibiotic selection for surgical prophylaxis.
- Cefazolin is more effective than vancomycin in preventing postoperative infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). See here for the role of vancomycin prophylaxis.
- S. aureus carriage increases the risk of postoperative infection; preoperative screening and targeted decolonisation may be warranted. See Preventing postoperative infections caused by S. aureus.
- Surgical antibiotic prophylaxis must be administered before surgical incision. For short-acting antibiotics, such as cefazolin, the dose should be administered no more than 60 minutes before incision. For antibiotics that are not short acting, the dose should be administered no more than 120 minutes before incision. See Timing of surgical antibiotic prophylaxis.
- A single preoperative dose of antibiotic(s) is sufficient for the significant majority of procedures. In specific circumstances, a repeat intraoperative dose may also be necessary. See Duration of surgical antibiotic prophylaxis.
- For a small minority of procedures, there are inadequate data to show that a single dose of prophylaxis is as effective as 24 hours of prophylaxis. For these procedures, postoperative doses can be considered but prophylaxis should not continue beyond 24 hours. See Duration of surgical antibiotic prophylaxis.
- Do not extend the duration of antibiotic prophylaxis because the patient has a urinary or intravascular catheter, or surgical drain, in situ.
Appropriate surgical antibiotic prophylaxis has been conclusively shown to reduce the rate of superficial incisional, deep incisional, and organ/space surgical site infections, as well as postoperative pneumonia and urinary tract infection.
Adherence to the principles in these guidelines maximises the potential benefit of surgical antibiotic prophylaxis while minimising potential harms, including the development of drug-resistant pathogens.