Prophylactic antibiotics for surgical wound infections - Tips from Other Journals

Date: June, 1992

Although improvements in the management of risk factors for surgical wound infection have reduced the rate of these infections considerably, postoperative wound infections still occur and contribute to longer hospital stays and increased medical costs. Prophylactic administration of antimicrobial agents is commonly used to reduce the incidence of such infections. To determine how the timing of antibiotic administration affects the risk of surgical wound infection in clinical practice, Classen and colleagues conducted a prospective study of antibiotic prophylaxis and the occurrence of surgical wound infections in patients undergoing elective surgery.

The study included 2,847 patients undergoing elective "clean" or "clean-contaminated" surgical procedures at a large community hospital. Clean surgical procedures were those in which there was no violation of aseptic technique and the alimentary, respiratory and genitourinary systems were not entered. Clean-contaminated procedures were those in which these systems were entered but without spillage. Antibiotics were administered two to 24 hours before surgery in 369 patients, two hours before surgery in 1,708 patients, within three hours after surgery in 282 patients, and more than three hours but less than 24 hours after surgery in 488 patients. The antibiotics most commonly used were cefazolin, cefonicid, cefoxitin and cefamandole.

Patients who received antibiotics two hours before surgery had the lowest incidence of wound infections (0.6 percent), compared with patients who received antibiotics more than two hours before surgery (3.8 percent), perioperatively (1.4 percent) and postoperatively (3.3 percent).

In a related editorial. Wenzel suggests that antibiotic prophylaxis may be of less benefit for minor procedures. In such cases, the widespread use of prophylactic agents may increase the number of antibiotic-resistant organisms and the number of adverse events. He notes that studies have shown that prophylactic antibiotics should not be prescribed for more than 48 hours. Until further studies are performed, he agrees that prophylactic antibiotics should be administered within two hours before clean or clean-contaminated procedures. (New England Journal of Medicine, January 30, 1992, vol. 326, pp. 281, 337.)

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