Prophylactic Antibiotics and Prevention of Surgical Site Infections

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Key points

  • Surgical site infections (SSIs) are the most common type of healthcare-associated infection in the United States, affecting more than 500,000 patients annually. Studies suggest that 40% to 60% of these infections may be preventable.

  • Patients diagnosed with SSI face a 2 to 11 times increase in mortality along with prolonged hospital stays, treatment-associated risks, and potential long-term sequelae.

  • Nationwide efforts to improve SSI rates include monitoring compliance with preventive guidelines

Clinical and Social Costs

SSIs represent a significant clinical and financial burden. Those diagnosed with an SSI face a 2 to 11 times increase in mortality.9, 10 Although most survive their infection, prolonged hospital stays and secondary risks associated with treatment are common.11 Even when patients recover, many find their overall quality of life is significantly impacted over the long term.12 In addition to these clinical concerns, associated costs can range from $400 for superficial SSI to upward of $30,000 for

Antibiotic Prophylaxis

Appropriately selected antibiotic prophylaxis can protect patients from postoperative infection by reducing the bacterial load present within the surgical site at the time of operation.20 In addition to specific risks to patients, however, the increasing burden of fungal and antibiotic-resistant organisms highlights the importance of evidence-based practice and antibiotic stewardship.21, 22

Antibiotic Selection

Evidence-based guidelines should direct antibiotic selection guided by the organisms most commonly linked

Surgical Safety Checklists

Checklist use has been associated with improved compliance with antibiotic administration guidelines and significantly lower SSI rates in several global trials.30, 31 However, implementation factors loom large. Buy-in from front-line providers is critical, because large-scale mandatory implementation without extensive training likely mitigates impact.32

Skin Decontamination

Preoperative patient-applied chlorhexidine scrubs may decrease SSI rates as compared with no bathing; however, a significant benefit over

Irrigation

Several studies over the past three decades have evaluated wound and intracavity irrigation with regard to SSI rates. The secular effects of increased evidence-based antibiotic prophylaxis make studies difficult to interpret; however, there seems to be little evidence in support of irrigation to prevent SSI in current practice.40

Laparoscopy

Laparoscopy is generally associated with decreased SSI rates in virtually all procedures in which it is a viable technique.41, 42, 43, 44 In light of this, some authors

Antibiotic Prophylaxis

The routine use of postoperative antibiotics for infection prophylaxis beyond 24 hours has not been shown to decrease SSI rates in general surgery.57 In light of adverse effects including antibiotic-associated diarrhea and the development of multidrug-resistant organisms, postoperative antibiotic prophylaxis should not be used in patients without evidence of infection or significant contamination intraoperatively.25 A growing awareness of antibiotic overuse has led to the development of SCIP

Summary

SSIs are the most common type of HAI in the United States, affecting more than 500,000 patients annually.4 Patients diagnosed with SSI, some 40% to 60% of which may be preventable, face a 2 to 11 times increase in mortality along with prolonged hospital stays, treatment-associated risks, and potential long-term sequelae.7, 9, 10, 12

The widespread impact of SSI has led to nationwide efforts to improve infection rates by monitoring compliance with preventive guidelines via the SCIP along with

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    Conflict of Interest: None.

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