Important issues for perioperative systemic antimicrobial prophylaxis in surgery

Abstract

Purpose of review: Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and important concepts in the field.

Recent findings: Joint guidelines (American Society of Health-System Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America) for antimicrobial prophylaxis in surgery have been recently revised and updated. Furthermore, European Centre for Disease Prevention and Control has issued a report identifying key factors for success. Important updated fields include the duration of prophylaxis; the selection and dosing of the antimicrobial drug; the precise timing of administration; and common and basic principles, including the implementation of local guidelines and attributing the responsibility of appropriate timing to anaesthesiologists. Additionally, the role of preoperative selective digestive decontamination (SDD) in gastrointestinal surgery receives increasing attention. A major concern of SDD, namely increasing microbial resistance, has not been demonstrated to date.

Summary: Most frequently, anaesthesiologists administer perioperative antimicrobial prophylaxis. Identification of core principles and harmonization of protocols should facilitate this task and thus help to improve patient safety and to monitor compliance. However, local and regional epidemiology have to be taken into account in order to establish local protocols.