Perioperative Antibiotic Prophylaxis

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 3926

Special Issue Editor


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Guest Editor
Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA
Interests: surgical infections; prevention; diagnosis; and treatment

Special Issue Information

Dear Colleagues,

Surgical site infections (SSI) are among the most common infections in hospitalized patients and cause significant financial cost and increased morbidity and mortality. Preventing SSIs from developing involves multiple issues in the preparation and performance of surgical procedures, only one of which is the optimal use of prophylactic antibiotics. This Special Issue invites manuscript submissions that evaluate issues and questions regarding the optimal use of prophylactic antibiotics for reducing the risk of SSI. There are many potential topics/questions in this area including the following:

  1. Which surgical procedures benefit from prophylaxis?
  2. Which antibiotic should you use?
    1. Should your antibiotic choice be influenced by antimicrobial susceptibility data for your institution?
    2. Should a history of prior soft tissue infections and/or SSI influence antibiotic choice?
    3. Are there settings in which prior cultures should be taken from the patient before operation to influence antibiotic choice, such as in patients with biliary stents before pancreatic or hepatic operations?
    4. Can a patient with penicillin allergy get a cephalosporin?
  3. When should you start antibiotic treatment? Various guidelines say within 120 minutes or 60 minutes before incision, but is there a problem with starting only 10–15 minutes before incision?
  4. Does the amount of antibiotic measured in serum or in the tissue being operated on influence infection risk?
  5. What dose should be administered?
  6. When should a second dose be given during the operation?
  7. For what duration of time should prophylactic antibiotics be administered?

Prof. Dr. Evan Patchen Dellinger
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surgical site infection
  • prophylaxis
  • antibiotic choice
  • timing
  • dose
  • duration
  • allergy

Published Papers (3 papers)

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Review

14 pages, 775 KiB  
Review
Management of Penicillin Allergy in the Perioperative Setting
by Mary Elizabeth Sexton and Merin Elizabeth Kuruvilla
Antibiotics 2024, 13(2), 157; https://doi.org/10.3390/antibiotics13020157 - 05 Feb 2024
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Abstract
The selection of perioperative antibiotic prophylaxis is challenging in patients with a history of penicillin allergy; as such, we present a literature review exploring current best practices and the associated supporting evidence, as well as areas for future research. Guidelines recommend the use [...] Read more.
The selection of perioperative antibiotic prophylaxis is challenging in patients with a history of penicillin allergy; as such, we present a literature review exploring current best practices and the associated supporting evidence, as well as areas for future research. Guidelines recommend the use of alternative agents in patients with an IgE-mediated hypersensitivity reaction, but those alternative agents are associated with worse outcomes, including an increased risk of surgical site infection, and higher cost. More recent data suggest that the risk of cross-reactivity between penicillins and cephalosporins, particularly cefazolin, is extremely low, and that cefazolin can be used safely in most penicillin-allergic patients. Studies have therefore explored how best to implement first-line cefazolin use in patients with a penicillin allergy label. A variety of interventions, including preoperative allergy de-labeling with incorporation of penicillin skin testing, use of patient risk-stratification questionnaires, and utilization of clinician algorithms to guide antibiotic selection intraoperatively, have all been shown to significantly increase cefazolin utilization without a corresponding increase in adverse events. Further studies are needed to clarify the most effective interventions and implementation strategies, as well as to evaluate whether patients with severe delayed hypersensitivity reactions to penicillin should continue to be excluded from receipt of other beta-lactams. Full article
(This article belongs to the Special Issue Perioperative Antibiotic Prophylaxis)
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17 pages, 310 KiB  
Review
Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery
by Mason Vierra, Mohsen Rouhani Ravari, Fatemeh Soleymani Sardoo and Benjamin D. Shogan
Antibiotics 2024, 13(1), 99; https://doi.org/10.3390/antibiotics13010099 - 19 Jan 2024
Viewed by 1188
Abstract
The average American today undergoes three inpatient and two outpatient surgical procedures during one’s life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but [...] Read more.
The average American today undergoes three inpatient and two outpatient surgical procedures during one’s life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient’s risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory “pathobiome” following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient’s prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis. Full article
(This article belongs to the Special Issue Perioperative Antibiotic Prophylaxis)
21 pages, 1654 KiB  
Review
Effective Antimicrobial Prophylaxis in Surgery: The Relevance and Role of Pharmacokinetics-Pharmacodynamics
by Sheryl A. Zelenitsky
Antibiotics 2023, 12(12), 1738; https://doi.org/10.3390/antibiotics12121738 - 14 Dec 2023
Viewed by 1183
Abstract
Appropriate surgical antimicrobial prophylaxis (SAP) is an important measure in preventing surgical site infections (SSIs). Although antimicrobial pharmacokinetics–pharmacodynamics (PKPD) is integral to optimizing antibiotic dosing for the treatment of infections, there is less research on preventing infections postsurgery. Whereas clinical studies of SAP [...] Read more.
Appropriate surgical antimicrobial prophylaxis (SAP) is an important measure in preventing surgical site infections (SSIs). Although antimicrobial pharmacokinetics–pharmacodynamics (PKPD) is integral to optimizing antibiotic dosing for the treatment of infections, there is less research on preventing infections postsurgery. Whereas clinical studies of SAP dose, preincision timing, and redosing are informative, it is difficult to isolate their effect on SSI outcomes. Antimicrobial PKPD aims to explain the complex relationship between antibiotic exposure during surgery and the subsequent development of SSI. It accounts for the many factors that influence the PKs and antibiotic concentrations in patients and considers the susceptibilities of bacteria most likely to contaminate the surgical site. This narrative review examines the relevance and role of PKPD in providing effective SAP. The dose–response relationship i.e., association between lower dose and SSI in cefazolin prophylaxis is discussed. A comprehensive review of the evidence for an antibiotic concentration–response (SSI) relationship in SAP is also presented. Finally, PKPD considerations for improving SAP are explored with a focus on cefazolin prophylaxis in adults and outstanding questions regarding its dose, preincision timing, and redosing during surgery. Full article
(This article belongs to the Special Issue Perioperative Antibiotic Prophylaxis)
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