Table 1.
Recommendations for Antibiotics Management
| Antibiotic Prophylaxis (AP) |
|---|
| • Perioperative SSI prevention strategies should include attention to |
| -infection control strategies |
| -surgical technique |
| -hospital and operating room environments |
| -instrument sterilization processes |
| -perioperative optimization of patient risk factors |
| • AP should be administered for operative procedures that have a high rate of postoperative surgical site infection, or when foreign material is implanted. |
| • AP should be bactericidal, nontoxic, and inexpensive. It should have in vitro activity against the common organisms that cause postoperative surgical site infection after a specific surgical procedure. Broad-spectrum antibiotics should be avoided for surgical prophylaxis. |
| • AP should be administered not more than 30 to 60 minutes before surgery. Therapeutic concentrations of antimicrobial agents should be present in the tissue throughout the period that the wound is open. |
| • Additional antibiotic doses should be administered intraoperatively for prolonged procedures. |
| • Prolonged postoperative AP should be always discouraged. |
| Antibiotic therapy |
|---|
| • Antimicrobial agents should be used after a treatable IAI has been recognized or if there is a high degree of suspicion of an infection. |
| • Empiric antimicrobial therapy should be started in patients with surgical infection. |
| • Knowledge of local rates of resistance should be always an essential component in the determination of the empiric antimicrobial regimen. |
| • For patients with community-acquired infections, empiric agents with narrower spectra of activity are preferred. |
| • For patients with hospital-acquired infections, antimicrobial regimens with broader spectra of activity are preferred. |
| • Targeted antimicrobial therapy regimens should be adapted when culture and antimicrobial susceptibility test results are available. |
| • The antimicrobial therapy should be shortened in patients with no signs of on-going infection. |
| • Patients having signs of sepsis beyond 5 to 7 days of antibiotic treatment should undergo aggressive diagnostic investigation to determine an ongoing uncontrolled source of infection or antimicrobial treatment failure. |
SSI = surgical site infection; IAI = intra-abdominal infection.