special subjects
Prevention of Surgical Infections
Introduction
Most surgical procedures do not require prophylactic or postoperative antibiotics. However, certain patient-related and procedure-related factors alter the risk/benefit ratio in favor of prophylactic use. Patient-related risk factorssuggesting need for antibiotics include Certain Prevention None Immunosuppression Procedures with higher riskinvolve areas where bacterial seeding is likely: Mouth Gastrointestinal tract Respiratory tract Genitourinary tract In so-called clean (likely to be sterile) procedures, prophylaxis generally is beneficial only when prosthetic material or devices are being inserted or when the consequence of infection is known to be serious (eg, mediastinitis after coronary artery bypass grafting). ( see Perioperative Management ). There is strong evidence that standardizing antibiotic choices and adhering to SCIP protocols or another standardized and validated protocol reduce the risk of surgical infection. Some regions of the US that followed SCIP guidelines were able to decrease surgical site infections by 25% from 2006 to 2010. Drug choice is based on the drug's activity against the bacteria most likely to contaminate the wound during the specific procedure ( see Table: The Center for Disease Control has publishedguidelinesfor prevention of surgical site infections that address topical and nondrug antiseptic measures (eg, bathing, sealants, irrigation, prophylaxis for prosthetic devices). 