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Antimicrobial Prophylaxis in Surgery: Mechanisms, Misconceptions, and Mischief

There is a major misconception among many surgeons about need for prolonged postoperative use of antimicrobial prophylaxis in preventing operative site infections. For example, among community hospital members of the Florida Consortium for Infection Control there is a mean duration of four days' use of intravenous antimicrobials in uninfected patients immediately following elective large bowel operations (Ehrenkranz NJ, unpublished data). Historically, much of the early work demonstrating antimicrobial prophylactic efficacy in large bowel operations was done at Jackson Memorial Hospital in Miami by Hiram Polk more than 20 years ago. A number of then surgical residents who took part in these studies, writing orders for only three doses of prophylactic drug, are now senior surgeons in active practice in Florida. Some of these surgeons currently prescribe prolonged postoperative courses of antimicrobials following large bowel surgery in uninfected patients. This is both mystifying and disconcerting.