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Antimicrobial Prophylaxis in Surgery: Mechanisms, Misconceptions, and Mischief

Published online by Cambridge University Press:  21 June 2016

N. Joel Ehrenkranz
N. Joel Ehrenkranz*
Affiliation:
Florida Consortium For Infection Control, South Miami, Florida
*
Florida Consortium for Infection Control, 5901 SW 74th Street, Suite 300, South Miami, FL 33143
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Extract

There is a major misconception among many surgeons about need for prolonged postoperative use of antimicrobial prophylaxis in preventing operative site infections. For example, among community hospital members of the Florida Consortium for Infection Control there is a mean duration of four days' use of intravenous antimicrobials in uninfected patients immediately following elective large bowel operations (Ehrenkranz NJ, unpublished data). Historically, much of the early work demonstrating antimicrobial prophylactic efficacy in large bowel operations was done at Jackson Memorial Hospital in Miami by Hiram Polk more than 20 years ago. A number of then surgical residents who took part in these studies, writing orders for only three doses of prophylactic drug, are now senior surgeons in active practice in Florida. Some of these surgeons currently prescribe prolonged postoperative courses of antimicrobials following large bowel surgery in uninfected patients. This is both mystifying and disconcerting.

Type
Readers' Forum
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 2 , February 1993 , pp. 99 - 106
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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References

1. Polk, HC, Lopez-Mayor, JE Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969;66:97–103.Google ScholarPubMed
2. Bernard, HR. Cole, WR. The oronhvlaxis of surgical infection. Surgery. 1964;56:151–157.Google ScholarPubMed
3. DiPiro, JT, Cheung, RP, Bowden, TA Jr, Mansberger, JA. Single dose systematic antibiotic prophylaxis of surgical wound infections. Am J Surg. 1986;152:552–559.CrossRefGoogle Scholar
4. Slonim, R, Litwak, RS, Gadboys, HL, Ehrenkranz, NJ. Antibiotic prophylaxis of infection complicating open-heart operations. Antimicrob Agents Chemother. 1963, 1964;731–735.Google Scholar
5. Stone, HH. Prophylactic and preventive antimicrobial therapy. Ann Surg. 1979;189:691–699.CrossRefGoogle Scholar
6. Edlich, RF, Rogers, W, Rasper, G, et al. Studies in the manage ment of the contaminated wound. Am J Surg. 1969;117:323–329.CrossRefGoogle Scholar
7. Raahave, D, Friis-Miller, A, Bjerre-Jepsen, K, Thiis-Knudsen, J, Rasmussen, LB. The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. Arch Surg. 1986;121:924–929.CrossRefGoogle ScholarPubMed
8. Hollang, ET, Ahmet, Z. Intraoperative wound contamination during abdominal hysterectomy. J Hosp Infect. 1991;19:181–189.Google Scholar
9. Dougherty, SH, Simmons, RL. Endogenous factors contributing to orosthetic device infection Infect Dis Clin North Am. 1989;3:199–209.CrossRefGoogle Scholar
10. Groner, JI. The efficacy of oral antimicrobials in reducing aerobic and anaerobic colonic mucosal flora. Arch Surg. 1989:124:281–284.CrossRefGoogle ScholarPubMed
11. Craig, WA. Soft tissue infection and osteomyelitis. Infections in Medicine. 1992;9(suppl B):13–14.Google Scholar
12. Vogelman, B, Gudmundsson, S, Leggett, J, et al. Correlation of antimicrobial pharmokinetic parameters with therapeutic efficacy in an animal model. J Infect Dis. 1988;158:831–847.CrossRefGoogle Scholar
13. Craig, WA, Vogelman, B. The postantibiotic effect. Ann Intern Med. 1987;106:900–902.CrossRefGoogle ScholarPubMed
14. Classen, DC, Evans, RS, Pestotnik, SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326:281–286.CrossRefGoogle ScholarPubMed
15. The Medical Letter on Drugs and Therapeutics. Antimicrobial prophylaxis in surgery. Medical Letter Inc. 1992;34:5–8.Google Scholar
16. Goldmann, DA Cephalosporin prophylaxis in cardiac valve surgery. J Thorac Cardiovasc Surg. 1977;73:470–479.CrossRefGoogle ScholarPubMed
17. Polk, HC Jr., Trachtenberg, MA, Finn, MP. Antibiotic activity in surgical incisions. JAMA. 1980;244:1353–1354.CrossRefGoogle ScholarPubMed
18. Gorbach, SL. Antimicrobial prophylaxis for appendectomy and colorectal surgery. Rev Infect Dis. 1991;13(suppl 10):S815–820.CrossRefGoogle ScholarPubMed
19. Mandell, GL, Sande, MA. Antimicrobial agents. In: Gilman, AG, Rall, TW, Nies, AS, Twlor, P eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY: Pergamon Press Inc; 1990:1053.Google Scholar
20. Faro, S, Martens, MG, Hammill, HA, Riddle, G, Tortolero, G. Antibiotic prophylaxis: Is there a difference? Am J Obstet Gynecol. 1990;162:900–909.CrossRefGoogle ScholarPubMed
21. Probst, JR. Comparison of one dose cefazolin versus one dose cefotetan for cesarean section prophylaxis. J Fla Med Assoc. 1989;76:1027–1029.Google ScholarPubMed
22. Ledger, WJ. Infections of the female pelvis. In: Mandell, GL, Douglas, RG, Bennett, JE. Principles and Practice of Infectious Disease. 3rd ed. New York. NY: Churchhill Livingston: 1990:965–970.Google Scholar
23. Jones, RN, Wojeski, W, Bakke, J, Porter, C, Searles, M. Antibiotic prophylaxis of 1036 patients undergoing elective surgical procedures. Am J Surg. 1987;153:341–346.CrossRefGoogle ScholarPubMed
24. Rosenberg, JM. Clostridium difficile colitis in surgical patients. Am J Surg. 1984;147:486–491.CrossRefGoogle ScholarPubMed
25. Yee, J, Dixon, CM, McLean, PH, Meakins, JL. Clostridium difficile disease in a department of surgery. The significance of prophylactic antibiotics. Arch Surg. 1991;126:241–246.CrossRefGoogle Scholar
26. DeChamp, C. Prospective survey of colonization and infection caused by expanded-spectrum-B-lactamase-producing members of the family Entero-bacteriaceae in an intensive care unit. J Clin Microbial. 1989;27:2887–2890.CrossRefGoogle Scholar
27. Platt, R, Zaleznik, DE Hopkins, CC, et al. Perioperative antibiotic prophylaxis for herniorrhapy and breast surgery. N Engl J Med. 1990;322:153–160.CrossRefGoogle Scholar
28. Hirschman, JV, Innui, 'IS. Antimicrobial prophylaxis: a critique of recent trials. Rev Infect Dis. 1980;2:1–24.CrossRefGoogle Scholar
29. Beam, TR. First generation cephalosporins in surgical practice. Infect in Surg. 1988;7:175–183.Google Scholar
30. DaJani, AS, Bisno, AL, Chung, KJ, et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. JAMA. 1990;264:2919–2922.CrossRefGoogle ScholarPubMed
31. Archer, GL. Alteration of Staphylococcal flora as a consequence of antimicrobial prophylaxis. Rev Infect Dis. 1991;13(suppl 10);S805–809.CrossRefGoogle Scholar
32. Flynn, DM, Weinstein, RA, Nathan, C, Gaston, MA, Kabins, SA. Patients' endogenous flora as the source of “nosocomial” Enterobacter in cardiac surgery. J Infect Dis. 1987;156:363–368.CrossRefGoogle Scholar
33. Sanders, CC. New β lactams: new problems for the internist. Ann Intern Med. 1991;115:650–651.CrossRefGoogle ScholarPubMed
34. Ariano, RE, Zhanel, GE. Antimicrobial prophylaxis in coronary bypass surgery: a critical appraisal. Drug Intelligence and Clinical Pharmacy, The Annals of Pharmacol Therapy. 1991;25:478–484.Google ScholarPubMed
35. Lowry, PW. Blankenshio, RI. Gridlev, W. Troup, NJ. Tompkins, LS. A cluster of Legionella sternal-wound infections due to postoperative topical exposure to contaminated tap water. N Engl J Med. 1991;324:109–113.CrossRefGoogle ScholarPubMed
36. Ehrenkranz, NJ, Pfaff, SJ. Mediastinitis complicating cardiac operations: evidence of postoperative causation. Rev Infect Dis. 1991;13:803–814.CrossRefGoogle ScholarPubMed
37. Burke, JE Identification of the sources of Staphylococci contaminating the surgical wound during operation. Ann Surg. 1963;158:898–904.CrossRefGoogle ScholarPubMed
38. Longfield, JN. Methicillin-resistant Staphylococcus aureus (MRSA). Infect Control. 1985;6:445–450.CrossRefGoogle Scholar
39. Nichols, RL. Proohylaxis in abdominal surgery. In: Peterson, PK. Verhoef, J, eds. The Antimicrobial Agents Annual 3. New York: NY: Elsevier; 1988:477–499.Google Scholar
40. Condon, RE. Antibiotic prophylaxis in gastrointestinal surgery. In: Davis, JM, Shires, GT; eds. Principles and Management of Surgical Infection. Philadelphia, Pa: JP Lippincott Co.; 1991:131–148.Google Scholar
41. Ehrenkranz, NJ. Containing costs of antimicrobials in the hospital: a critical evaluation. Am J Infect Control. 1989;17:300–310.CrossRefGoogle ScholarPubMed
42. Kernodle, DS, Classen, DC, Burke, JP, Kaiser, AB. Failure of cephalosporins to prevent Staphylococcus aureus surgical wound infections. JAMA. 1990;263:961–966.CrossRefGoogle ScholarPubMed
43. Kaiser, AB, Herrington, JL Jr, Jacobs, JK, et al. Cefoxitin versus erythromycin, neomycin and cefazolin in colorectal operations. Ann Surg. 1983;198:525–530.CrossRefGoogle ScholarPubMed
44. Galundiuk, S, Polk, HC, Jagelman, DG, Fazio, VW. Re-emphasis of priorities in surgical antibiotic prophylaxis. Surg Gynecol Obstet. 1989;169:219–222.Google Scholar
45. Jain, NK, Larson, DE, Schroeder, Kw, et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. Ann Intern Med. 1987;107:824–828.CrossRefGoogle ScholarPubMed
46. Jonas, SK Neimark, S, Panwalker, AP. Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1985;80:438–441.Google ScholarPubMed
47. Eigel, P, Tschinkor, A, Satter, P, Knothe, H. Assays of cephalosporin antibiotics administered prophylactically in open heart surgery. Infection. 1978;6:23–28.CrossRefGoogle ScholarPubMed
48. Ehrenkranz, NJ, Blackwelder, WC, Pfaff, SJ, et al. Infections complicating low-risk cesarean sections in community hospitals: efficacy of antimicrobial prophylaxis. Am J Obstet Gynecol. 1990;162:337–343.CrossRefGoogle ScholarPubMed
49. Gonik, B, Shannon, RL, Shawar, R, Costner, M, Seibel, M. Why oatients fail antibiotic prophylaxis at cesarean delivery. Obstet Gynecol. 1992;79:179–184.Google Scholar
50. Kaiser, AB. Antimicrobial prophylaxis of infections associated with foreign bodies. In: Bisno, AL. Waldvogel, FA. eds. Infection Associated With Indwelling Medical Devices. Washington, DC: American Society of Microbiology; 1989:277–287.Google Scholar
51. Boelaert, JR. Once weekly nasal mupirocin in hemodialysis patients. Presented at the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill; 1991.Google Scholar
52. Blum, MD. Infections of genitourinary prostheses. Infect Dis Clin North Am. 1989;3:259–274.CrossRefGoogle ScholarPubMed
53. Coit, DG, Peters, M, Brennan, ME A prospective randomized trial of perioperative cefazolin treatment in axillary and groin dissection. Arch Surg. 1991;126:1366–1372.CrossRefGoogle ScholarPubMed
54. Cerebrospinal fluid shunt infections. Luncet. 1989;i:1304–1305. Editorial.Google Scholar
55. Venes, JL. Infection of CSF shunt and intracranial monitoring devices. Infect Dis Clin North Am. 1989;3:289–299.CrossRefGoogle ScholarPubMed
56. Dempsey, R, Rapp, RP, Young, B, Johnston, S, Tibbs, P. Prophylactic parenteral antibiotics in clean neurosurgical procedures: a review. J Neurosurg. 1988;69:52–57.CrossRefGoogle ScholarPubMed
57. Dellinger, EP. Antibiotic prophylaxis in trauma. Rev Infect Dis. 1991;13(suppl 10):S847–857.CrossRefGoogle ScholarPubMed
58. Dellinger, EP, Caplan, ES, Weaver, LD, et al. Duration of preventive antibiotic administration for open fractures. Arch Surg. 1988;123:333–339.CrossRefGoogle Scholar
59. Norden, CW. Antibiotic prophylaxis in orthopedics. Rev Infect Dis. 1991;13(suppl 10):S842–846.10.1093/clinids/13.Supplement_10.S842CrossRefGoogle Scholar
60. Harding, GKM. How long should catheter-acquired urinary tract infection in women be treated? Ann Intern Med. 1991;114:713–719.CrossRefGoogle ScholarPubMed
61. Swanson, D, Maxwell, RA, Johnson, JT, Wagner, RL, Yu, VL. Cefonicid versus clindamycin prophylaxis for head and neck surgery in a randomized, doudle-blind trial, with pharmacokinetic implications. Antimicrob Agents Chemother. 1991;35:1360–1364.CrossRefGoogle Scholar
62. Taylor, EW, Lindsay, G. Antibiotic prophylaxis in transurethal resection of the prostate with reference to the influence of preoperative catheterization. J Hosp Infect. 1988:12:75–83.CrossRefGoogle Scholar
63. Ehrenkranz, NJ, Meakins, JL. Surgical infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, Mass: Little. Brown and Co. 1992685710.Google Scholar