Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle
Massimo Sartelli,
Federico Coccolini,
Francesco M. Labricciosa,
AbdelKarim. H. Al Omari,
Lovenish Bains,
Oussama Baraket,
Marco Catarci,
Yunfeng Cui,
Alberto R. Ferreres,
George Gkiokas,
Carlos Augusto Gomes,
Adrien M. Hodonou,
Arda Isik,
Andrey Litvin,
Varut Lohsiriwat,
Vihar Kotecha,
Vladimir Khokha,
Igor A. Kryvoruchko,
Gustavo M. Machain,
Donal B. O’Connor,
Iyiade Olaoye,
Jamal A. K. Al-Omari,
Alessandro Pasculli,
Patrizio Petrone,
Jennifer Rickard,
Ibrahima Sall,
Robert G. Sawyer,
Orlando Téllez-Almenares,
Fausto Catena,
Walter Siquini
Affiliations
Massimo Sartelli
Department of Surgery, Macerata Hospital, 62100 Macerata, Italy
Federico Coccolini
General, Emergency and Trauma Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy
Francesco M. Labricciosa
Global Alliance for Infections in Surgery, 62100 Macerata, Italy
AbdelKarim. H. Al Omari
Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
Lovenish Bains
Department of General Surgery, Maulana Azad Medical College, New Delhi 110002, India
Oussama Baraket
Department of General Surgery, Bizerte Hospital, Bizerte 7000, Tunisia
Marco Catarci
General Surgery Unit, Sandro Pertini Hospital, 00157 Rome, Italy
Yunfeng Cui
Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300052, China
Alberto R. Ferreres
Department of Surgery, University of Buenos Aires, Buenos Aires 1428, Argentina
George Gkiokas
Department of Surgery, Medical School, “Aretaieio” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
Carlos Augusto Gomes
Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora 25520, Brazil
Adrien M. Hodonou
Department of Surgery, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin
Arda Isik
Department of Surgery, Istanbul Medeniyet University, Istanbul 34000, Turkey
Andrey Litvin
Department of Surgical Diseases No. 3, Gomel State Medical University, 246000 Gomel, Belarus
Varut Lohsiriwat
Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Vihar Kotecha
Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Vladimir Khokha
General Surgery Unit, Podhalanski Specialized Hospital, 34-400 Nowy Targ, Poland
Igor A. Kryvoruchko
Department of Surgery No. 2, Kharkiv National Medical University, 61000 Kharkiv, Ukraine
Gustavo M. Machain
Department of Surgery, Universidad Nacional de Asuncion, San Lorenzo 1055, Paraguay
Donal B. O’Connor
Department of Surgery, School of Medicine, Trinity College, D02 PN40 Dublin, Ireland
Iyiade Olaoye
Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 240101, Nigeria
Jamal A. K. Al-Omari
Medical College, Al-Balqa Applied University, Al-Hussein Hospital, Zarqa 13313, Jordan
Alessandro Pasculli
Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Unit of Academic General Surgery “V. Bonomo”, University of Bari “A. Moro”, 70125 Bari, Italy
Patrizio Petrone
Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, NY 11501, USA
Jennifer Rickard
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
Ibrahima Sall
Department of General Surgery, Military Teaching Hospital, Dakar 3006, Senegal
Robert G. Sawyer
Department of Surgery, School of Medicine, Western Michigan University, Kalamazoo, MI 49008, USA
Orlando Téllez-Almenares
General Surgery Department of Saturnino Lora Provincial Hospital, University of Medical Sciences of Santiago de Cuba,
26P2+J7X, Santiago de Cuba 90100, Cuba
Fausto Catena
Department of Surgery, “Bufalini” Hospital, 47521 Cesena, Italy
Walter Siquini
Department of Surgery, Macerata Hospital, 62100 Macerata, Italy
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.
