Surgical antibiotic prophylaxis is an essential component of perioperative
care. The use of prophylactic regimens of antibiotics is a well-established practice that is encouraged
to be implemented in preoperative/perioperative protocols in order to prevent surgical site
infections.
The aim of this study was to emphasize the crucial aspects of antibiotic prophylaxis
in abdominal surgery.
Antibiotic prophylaxis is defined as the administration of antibiotics
before contamination occurs, given with the intention of preventing infection by achieving tissue
levels of antibiotics above the minimum inhibitory concentration at the time of surgical incision. It
is indicated for clean operations with prosthetic materials or in cases where severe consequences
may arise in the event of an infection. It is also suitable for all clean-contaminated and contaminated
operations. The spectrum of action is determined by the pathogens present at the surgical site.
Ideally, a single intravenous bolus dose should be administered within 60 min before the surgical
incision. An additional dose should be given in case of hemorrhage or prolonged surgery, according
to the half-life of the drug. Factors such as the patient’s weight, history of allergies, and the likelihood
of colonization by resistant bacteria should be considered. Compliance with institutional protocols
enhances the effectiveness of antibiotic use.
Surgical antibiotic prophylaxis is
associated with reduced rates of surgical site infection, hospital stay, and morbimortality.
Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis
Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients.
Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery.
There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable.
The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.
Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system.
To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery.
Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were “anti-bacterial agents”; “antibioticoprophylaxis” AND “surgical wound infection”. The inclusion criteria were articles of recent publication, with full texts available and performed in humans.
A total of 29 articles were evaluated and selected according to the eligibility criteria.
Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.
Desenvolvido por Surya MKT