Antibiotics
Written by Rhiana Devadasan
9) Antibiotics in surgery. Indications and complications.
Bacterial Infection
a proliferation of a harmful strain of bacteria on or inside the body. E.g. pneumonia, meningitis, food poisoning, etc. (NB: bacteria can infect any area of the body)
Uses of Antibiotics in Surgery
There are two occasions when we use antibiotics in surgery...
1. Surgical Infection Prophylaxis (i.e. to prevent infections at the surgical site)
2. Surgical Infection Treatment (i.e. to treat infections)
NB: appropriate antibiotic prophylaxis reduces the risk of postoperative wound infections HOWEVER excessive use can lead to antimicrobial resistance (refer to above). This is why it is important to know when to appropriate use antibiotics in surgery.
Deciding whether Surgical Antibiotic Prophylaxis is appropriate
Indications for surgical antibiotic prophylaxis:
- A classification system is used to rank procedures based on their potential risk for infectious complications
- Clean (e.g. mastectomy)
- healthy skin incised, mucosa of respiratory, alimentary, genitourinary tract and oropharyngeal cavity are NOT crossed
- e.g. herniorrhaphy, mastectomy, cosmetic surgery
- surgical antibiotic prophylaxis is NOT recommended
- Clean-contaminated (e.g. uncomplicated appendectomy)
- respiratory, alimentary or genitourinary tract is penetrated under controlled conditions without unusual contamination
- e.g. laryngectomy, uncomplicated appendiectomy, cholecystectomy, transurethral resection of prostate gland
- surgical antibiotic prophylaxis IS recommended
- Contaminated (e.g. large bowel resection)
- macroscopic soiling of operative field
- e.g. large bowel resection, biliary or genitourinary surgery w/ infected bile/urine
- surgical antibiotic prophylaxis is STRONGLY recommended
- This may then be used to determine the need for surgical antibiotic prophylaxis
NB: DO NOT use antibiotic prophylaxis to overcome poor surgical technique