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Perioperative Prophylactic Use of Antibiotics in Surgery: Principles and Practice

Published online by Cambridge University Press:  02 January 2015

Abstract

Prophylatic use of antimicrobics represents about 30% of total hospital use of these agents. Previous studies in animal models have suggested that timing of such prophylaxis is crucial, to the extent of the existence of a “critical period” for effective administration. This phenomenon has further been shown to exist in man, in numerous double-blind, controlled clinical trials in various types of surgical wounds. On these bases, we introduced new prophylactic protocols in a university hospital, specifically directed at reducing infection in high-risk procedures. Surveillance was conducted by infection control nurses, and one antibiotic-day was the comparative unit. Infection rates were markedly diminished under these new protocols. Total usage of antimicrobial drugs also decreased by 38% over previous rates. The rationale for limiting prophylaxis to a conscribed period was clearly demonstrated, although the exact mechanisms responsible for this effect are, as yet, unclear.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1982

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References

1.Shapiro, M, et al. Use of antimicrobial drugs in general hospitals. II. Analysis of patterns of use. J Infect Dis 1979; 139:698706.CrossRefGoogle ScholarPubMed
2.Sandusky, WR. Use of prophylactic antibiotics in surgical patients. Surg Clin North Am 1980; 60:8392.Google Scholar
3.Miles, AA, et al. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol 1957; 38:7996.Google Scholar
4.Shapiro, M, et al. Antibiotic prophylaxis of cutaneous lesions caused by Bacteroides fragilis in guinea pigs. The existence of a “Decisive Period”. J Infect Dis 1980; 141:532.Google Scholar
5.Burke, JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961; 50:161168.Google Scholar
6.Alexander, JW, Altemeier, WA. Penicillin prophylaxis of experimental staphylococcal wound infections. Surg Gynecol Obstet 1965; 120:243254.Google Scholar
7.Stone, HH, et al. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1979; 184:443452.Google Scholar
8.Conte, JE Jr, et al. Antibiotic prophylaxis and cardiac surgery: A prospective double-blind comparison of single-dose versus multiple-dose regimens. Ann Intern Med 1972; 76:943949.Google Scholar
9.Goldmann, DA, Hopkins, CC, Karchmer, AW. Cephalothin prophylaxis in cardiac valve surgery: A prospective, double-blind comparison of two-day and six-day regimens. J Thorac Cardiovasc Surg 1977; 73:470479.Google Scholar
10.Ledger, WJ, Gee, C, Lewis, WP. Guidelines for antibiotic prophylaxis in gynecology. Am J Obstet Gynecol 1975; 121:10381045.Google Scholar
11.Mendelson, J, et al. Effect of single and multidose cephradine prophylaxis on infectious morbidity of vaginal hysterectomy. Obstet Gynecol 1979; 53:3135.Google ScholarPubMed
12.Stone, HH, et al. Prophylactic and preventive antibiotic therapy: Timing, duration, and economics. Ann Surg 1979; 189:691699.CrossRefGoogle ScholarPubMed
13.Simchen, E, et al. The successful use of antibiotic prophylaxis in the prevention of wound infection in selected high-risk patients under non-trial everyday conditions. J Hosp Infect 1980; 1:211220.Google Scholar
14.Shapiro, M, et al. Antibiotic use on the surgical services of two Jerusalem hospitals, as determined by surveillance, and influenced by an intervention program. Rev Infect Dis, in press, 1981.CrossRefGoogle Scholar
15.Michel, J, Sacks, T, Simchen, E. Pattern of prophylactic use of antibiotics in six surgical departments of a teaching hospital in Jerusalem. Israel Journal of Medical Sciences 1977; 13:549556.Google ScholarPubMed