Perioperative Antibiotic Prophylaxis: Surgeons as Antimicrobial Stewards

Abstract

Infections in surgical patients have been recognized for millennia, but the negative consequences of how we prevent those infections is a relatively recent discovery. Indeed, as early as the seventh century, surgeons in Greece operating on patients with head trauma applied “healing drugs” at the time of operation to prevent inflammatory or infectious complications. 1 Agelarakis A. Early evidence of cranial surgical intervention in Abdera, Greece: A nexus to on head wounds of the Hippocratic corpus. Mediterranean Archaeology and Archaeometry. 2006; 6: 5-18 Google Scholar What we do with our surgical patients today is not much different. Definitive evidence supporting the use of perioperative antibiotic prophylaxis (PAP) to prevent surgical site infection (SSI) mounted at the end of the 20th century, and with it, so did data on the wide variability in prophylactic antibiotic choices. Preventing SSIs is good stewardship because the overwhelming majority of patients with a SSI get antibiotics, and potentially inappropriately used antibiotics, in some studies up to 12 days or longer. 2 Eagye K.J. Kim A. Laohavaleeson S. et al. Surgical site infections: does inadequate antibiotic therapy affect patient outcomes?. Surg Infect (Larchmt). 2009; 10: 323-331 Crossref PubMed Scopus (37) Google Scholar ,3 Jenkins T.C. Knepper B.C. Moore S.J. et al. Antibiotic prescribing practices in a multicenter cohort of patients hospitalized for acute bacterial skin and skin structure infection. Infect Control Hosp Epidemiol. 2014; 35: 1241-1250 Crossref PubMed Scopus (35) Google Scholar It stands to reason that minimizing the need for antibiotics is good stewardship. But in the attempt to minimize the risk of SSI, have surgeons become poor stewards of one of the important tools to combat these infections?

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