TY - JOUR
T1 - Surgical Antibiotic Prophylaxis
T2 - A Proposal for a Global Evidence-Based Bundle
AU - Sartelli, Massimo
AU - Coccolini, Federico
AU - Labricciosa, Francesco M.
AU - Al Omari, Abdel Karim H.
AU - Bains, Lovenish
AU - Baraket, Oussama
AU - Catarci, Marco
AU - Cui, Yunfeng
AU - Ferreres, Alberto R.
AU - Gkiokas, George
AU - Gomes, Carlos Augusto
AU - Hodonou, Adrien M.
AU - Isik, Arda
AU - Litvin, Andrey
AU - Lohsiriwat, Varut
AU - Kotecha, Vihar
AU - Khokha, Vladimir
AU - Kryvoruchko, Igor A.
AU - Machain, Gustavo M.
AU - O’Connor, Donal B.
AU - Olaoye, Iyiade
AU - Al-Omari, Jamal A.K.
AU - Pasculli, Alessandro
AU - Petrone, Patrizio
AU - Rickard, Jennifer
AU - Sall, Ibrahima
AU - Sawyer, Robert G.
AU - Téllez-Almenares, Orlando
AU - Catena, Fausto
AU - Siquini, Walter
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/1
Y1 - 2024/1
N2 - In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean–contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.
AB - In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean–contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.
KW - bundle
KW - healthcare-associated infections
KW - prevention
KW - surgical antibiotic prophylaxis
KW - surgical site infections
UR - http://www.scopus.com/inward/record.url?scp=85183107052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183107052&partnerID=8YFLogxK
U2 - 10.3390/antibiotics13010100
DO - 10.3390/antibiotics13010100
M3 - Review article
C2 - 38275329
AN - SCOPUS:85183107052
SN - 2079-6382
VL - 13
JO - Antibiotics
JF - Antibiotics
IS - 1
M1 - 100
ER -