ANALYSIS OF SURGICAL ANTIBIOTIC PROPHYLAXIS

Nosocomial infections (hereinafter NI) represent a serious problem in our hospitals with a frequency rate that may be in excess of 10%. Many of these infections (more than 50%) are the result of wounds caused to patients during surgery, which could be avoided with antibiotic Prophylaxis. The intention of this study is to review, on the one hand, and in the light of Evidence-Based Medicine (hereinafter EBM), the publications on this subject and, on the other, to survey and study the protocols currently used in centres in the network, the effectiveness, adverse effects and cost of the different procedures. This study, carried out with a multidisciplinary team, was made on 80-90% of the total number of operations performed.

AIMS

1. Determine the effectiveness of antibiotic prophylaxis procedures in surgery.
2. Determine the factors that affect the variability in their use
3. Verify non desired effects.
4. Consider the cost of each procedure from an objective viewpoint
5. Establish indications and standards for use.

MATERIAL AND METHODS

The subjects studied are the surgical services of the Basque public health care network (Osakidetza).

Design: the study will be carried out in the following stages:

1. Review and subsequent evaluation of the literature, collecting any information available in different databases.
2. Compilation and analysis of protocols.
3. Personal survey made among specialists in the different surgical services.

The research team is responsible for this entire process.

CONCLUSIONS

All the hospitals studied have a written protocol. All of these indicate single dosage and intravenous via (iv) as the means of administration. 80% of the hospitals have updated their protocol over recent years. 9.1% of the surgeons interviewed do not know of the existence of the protocol in their hospital centre. The single dosage is not used in 27% of the services and in 12.7% this is used only occasionally. This is applied on inducing the anaesthesia in 56.4% of cases.

RECOMMENDATIONS

The drug will be administered intravenously and on inducing the anaesthesia.

1. General Surgery
   Duodeno-Gastro-Esophageal surgery:
   • In LC and C surgery: Cefuroxima (cef 2nd gen)1.5 g or Amoxillin-clavulanate 2g.
   • If there is a risk of infection by Pseudomonas aeruginosa: Piperacillin-Tazobactam 4.5 g iv.
   • Allergy to B-lactamics: Gentamicine 160 mg + Clindamicine 600 mg iv.
   Hepatic-bile surgery:
   • Cefuroxime 1,5g iv o
   • Amoxillin-clavulanate 2 g iv.
   • Allergy to B-lactamics: Gentamicine 160 mg + Clindamicine 600 mg iv.
   Colon-rectum surgery
   • Amoxillin-clavulanate 2 g.
   • Allergy to B-lactamics: Gentamicina 160 mg + Clindamicine 600 mg.o Clindamicina + Metronidazol 1.5 g iv (more expensive).
2. Gynaecological surgery:
   • L and LC surgery: Amoxillin-clavulanate 2g.
   • Allergy to B-lactamics: Gentamicine 160 mg + Clindamicine 600 mg.
3. Maxilla-facial
   • L with implants: Cefazoline (cef 1st gen) 2 g iv
   • Allergy to B-lactamics: Clindamicine 600 mg
   • LC y C: Amoxillin-clavulanate 2 g iv. single dose with the induction of anesthesia.
   • Allergy to B-lactamics: Gentamicine 160 mg + Clindamicine 600 mg
4. Traumatological Surgery
   • L with implants: Cefazoline (cef 1st gen) 2g
   • Allergy: Vancomicina 1 g
5. Otorhinolaryngological surgery
   • L with implants: Cefazoline 2 g
   • LC and C: Amoxillin-clavulanate 2 g
   • Risk of intercranial passage: Cefotaxime 2 g o Ceftriaxone 1 g
   • Allergy: Clindamicine 600 mg iv + Tobramicine 200 mg.
6. Plastic surgery
   • L with implants, LC y C: Cefazoline 2g .
   • Allergy: Clindamicine 600 mg.
7. Thoracic surgery
   • L: Cefuroxime (cef 3rd gen) 1,5 g
   • LC and C: Cefuroxime 1.5 g iv or Amoxillin-clavulanate 2 g.
   • Allergy: Gentamicine 160 mg+Clindamicine 600 mg .
8. Urological surgery
   • LC and C: Tobramicine 200 mg
   The patients studied do not require prolongation of antibiotic prophylaxis.
9. Vascular Surgery
   • Cefazoline 2g.
   • With implants and repeat operations: Cefazoline 2g +Gentamicine 160 mg. Allergy: Vancomicine 1g.
10. Neurosurgery
    • L, LC: Amoxillin-clavulanate 2 g
    • Contact with SNC: Cefotaxime 2 g iv or Ceftriaxone 1 g
    • Shunt or allergies: Vancomicine 1 g.