Principles of appropriate antibiotic prophylaxis in surgery
1. Antibiotics alone are unable to prevent surgical site infections. Strategies to prevent surgical site infections should always include attention to:
• IPC strategies including correct and compliant hand hygiene practices
• Meticulous surgical techniques and minimization of tissue trauma
• Hospital and operating room environments
• Instrument sterilization processes
• Perioperative optimization of patient risk factors
• Perioperative temperature, fluid and oxygenation management
• Targeted glycemic control
• Appropriate management of surgical wounds
2. Antibiotic prophylaxis should be administered for operative procedures that have a high rate of postoperative surgical site infection, or when foreign materials are implanted.
3. Antibiotic given as prophylaxis should be effective against the aerobic and anaerobic pathogens most likely to contaminate the surgical site i.e., Gram-positive skin commensals or normal flora colonizing the incised mucosae.
4. Antibiotic prophylaxis should be administered within 120 minutes prior to the incision. However, administration of the first dose of antibiotics beginning within 30-60 minutes before surgical incision is recommended for most antibiotics (e.g. Cefazolin), to ensure adequate serum and tissue concentrations during the period of potential contamination. Obese patients ≥ 120 kg require higher doses of antibiotic.
5. A single dose is generally sufficient. Additional antibiotic doses should be administered intraoperatively for procedures >2-4 hours (typically where duration exceeds 2 half-lives of the antibiotic) or with associated significant blood loss (>1.5L).
6. There is no evidence to support the use of post-operative antibiotic prophylaxis.
7. Each institution is encouraged to develop guidelines for the proper surgical prophylaxis.