Prophylactic antibiotics are given to counter the risk of wound infection which occurs in ~20% of elective surgeries and up to 60% in emergency surgery
- Staphylococcus aureus: This bacterium, particularly the methicillin-resistant Staphylococcus aureus (MRSA)
- Escherichia coli (E. coli): Gram-negative
- Enterococci: These bacteria, such as Enterococcus faecalis and Enterococcus faecium, particularly in abdominal and pelvic surgeries.
- Pseudomonas aeruginosa: Gram-negative
- Clostridium perfringens: This anaerobic bacterium can cause infections in wounds with poor blood supply and low oxygen levels.
- Bacteroides fragilis: Another anaerobic bacterium, especially in abdominal surgeries.
- Candida species: Fungal infections, particularly those caused by Candida albicans, especially in immunocompromised patients or in surgeries involving the gastrointestinal tract.
Antibiotic prophylaxis should not be used routinely for clean non-prosthetic uncomplicated surgery because of the risk of adverse events, Clostridium difficile-associated disease, resistance and drug hypersensitivity.
| Category | Description | Infection Risk |
|---|---|---|
| Clean | Incising uninfected skin without opening a viscus | <2% |
| Clean-contaminated | Intra-operative breach of viscus (but not colon) | 8-10% |
| Contaminated | Breach of viscus + spillage or opening of colon | 12-20% |
| Dirty | The site is already contaminated with pus or faeces or from exogenous contagion eg trauma | 25% |
- IV antibiotics given 30 mins prior to surgery to maximise skin concentration
- Use antibiotics that will kill anaerobes and coliforms
- For MRSA colonised patients add teicoplanin or vancomycin
| Nature of operation | Antimicrobial program | Penicillin-allergic patient |
|---|---|---|
| Cardiothoracic | Cefuroxime 1.5g q12h | Vancomycin 1g q12 + Ciprofloxacin 400 mg q12h |
| Colorectal | Tazocin 4.5g q8h | Gentamicin 1.5mg/kg + Metronidazole 500mg |
| General Surgery | Cefazolin 1g | Vancomycin 1g OR Clindamycin 900mg |
| Oesophageal or gastric surgery | Tazocin 4.5g q8h | Gentamicin 1.5mg/kg |
| Vascular surgery | Cefazolin 1g or Tazocin 4.5g | Vancomycin 1g or Clindamycin 900mg |