Prevention of Surgical Site Infection

Surgical site infection prevention is important to avoid infection-related complications. In addition, some patients are at increased risk of developing endocarditis following a procedure. Many surgical procedures do not require prophylactic or postoperative antibiotics. However, patient-related and procedure-related factors should be evaluated to determine if prophylaxis should be given.

Patient-related risk factors suggesting need for antibiotics include

• Certain valvular heart disorders

• Immunosuppression

Procedures with higher risk involve 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) (1, 2).

Antibiotic choice is based on the drug's activity against the bacteria most likely to contaminate the wound during the specific procedure (see table Antibiotic Coverage for Certain Surgical Procedures

The Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection addresses topical and nonpharmacologic antiseptic measures (eg, bathing, sealants, irrigation, prophylaxis for prosthetic devices).

Antibiotics for prevention of infective endocarditis may be required for patients with certain risk factors, depending on the type of procedure. Guidelines for endocarditis prophylaxis have been provided by the American Heart Association and the European Society of Cardiology.

The effectiveness of different antiseptic agents used prior to surgery on contaminated or dirty wounds to reduce infections has not been extensively investigated (3).