Antibiotics in Surgery | Prophylactic Antibiotics

Antibiotics are commonly used in infected and critically colonized wounds to eradicate the infection and allow the wound to follow the normal physiological healing pathway. However, although prophylactic antibiotics are not recommended due to the risk of building host resistance, antibiotics also have an important role in preventing infection in the specific case of surgical wounds.

Surgical site infections are a leading cause of nosocomial infections after surgery, accounting for approximately 500,000 infections every year in the US and costing more than $1.6 billion annually.(1) It has been shown that patients who develop surgical site infections are five times more likely to be readmitted to hospital and twice as likely to die compared with surgical patients without the infections.(1)

The Surgical Care Improvement Project (SCIP), implemented in 2003, aims to  reduce post-operative site infections by recommending a number of measures, including the following:(2)

• Prophylactic antibiotics should be initiated within one hour before surgical incision, or within two hours if the patient is receiving vancomycin or fluoroquinolones.
• Patients should receive prophylactic antibiotics appropriate for their specific procedure.
• Prophylactic antibiotics should be discontinued within 24 hours of surgery completion (within 48 hours for cardiothoracic surgery).

Despite demonstrated reductions in surgical site infections following implementation of these measures, the use of prophylactic antibiotics in surgery is still not universal.(1) As an incentive to reduce rates of surgical site infections, the Centers for Medicare and Medicaid Services have begun reducing reimbursement for hospitals with high rates of surgical site infection.(1)

For most patients undergoing clean-contaminated surgeries (e.g., cardiothoracic, gastrointestinal, orthopedic, vascular, gynecologic), a cephalosporin is the recommended prophylactic antibiotic.(1,3,4) Other, generalized recommendations for prophylaxis based on type of surgery are given in the Table below.(1)

Prevention of wound infection is an essential skill in wound management, and an important part of the wound care certification program.

Table. Antibiotic prophylaxis to prevent surgical site infections¹

Surgery	Common pathogens	Recommended antimicrobials
Cardiothoracic	Staphylococcus aureus, coagulase-negative staphylococci	Cefazolin, cefuroxime sodium (Zinacef), or vancomycin
Gastrointestinal	Enteric gram-negative bacteria, anaerobes, enterococci	Cefoxitin (Mefoxin), cefotetan (Cefotan), ampicillin/sulbactam (Unasyn), or cefazolin plus metronidazole
Gynecologic	Enteric gram-negative bacteria, group B streptococci, enterococci, anaerobes	Cefoxitin, cefotetan, cefazolin, or ampicillin/sulbactam
Orthopedic	S. aureus, coagulase-negative staphylococci	Cefazolin, cefuroxime sodium, or vancomycin
Vascular	S. aureus, coagulase-negative staphylococci, enteric gram-negative bacilli	Cefazolin or vancomyc

Learn More With Our Wound Care Education Options

Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.

References

1. Salkin AR and Rao KC. Antibiotic prophylaxis to prevent surgical site infections. Am Fam Physician. March, 2011; 83(5): 585-90.
2.  Bratzler DW and Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43(3):322–330.
3. Landis SJ. Chronic Wound Infection and Antimicrobial Use. Adv Skin & Wound Care 2008; 21: 531–540.
4. Bates-Jensen BM, Ovington LG. Management of exudate and infection. In: Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.