National Guidelines for Antimicrobial Prophylaxis in Surgery
Clinical Pharmacy Department, New Capital Hospital — Evidence-based protocols for surgical infection prevention
Introduction
Prophylaxis refers to the prevention of an infection and can be characterized as primary prophylaxis, secondary prophylaxis, or eradication. These guidelines focus on primary perioperative prophylaxis in surgical procedures associated with a high rate of infection (i.e., clean-contaminated or contaminated procedures) and in certain clean procedures where there are severe consequences of infection (e.g., prosthetic implants). Recommendations are provided for adult (age above 18 years), pediatric (age 1-18 years) patients, infants (age ≥28 days - ≤1 years) and neonates (age <28 days).
Goals of Surgical Prophylaxis
Surgical Wound Classification (CDC)
Clean
An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered.
Clean-Contaminated
Operative wounds in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Contaminated
Open, fresh, accidental wounds. Operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract.
Dirty or Infected
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.
Preoperative-Dose Timing
The optimal time for administration of preoperative doses is within 60 minutes before surgical incision. Some agents, such as fluoroquinolones and vancomycin, require administration over one to two hours; therefore, the administration of these agents should begin within 120 minutes before surgical incision.
Intraoperative Redosing
The redosing interval should be measured from the time of administration of the preoperative dose, not from the beginning of the procedure. For all patients, intraoperative redosing is needed if the duration of the procedure exceeds two half-lives of the drug or there is excessive blood loss during the procedure (i.e., >1500 mL).
Staphylococcus aureus Screening
Screen for Staphylococcus aureus (MSSA and MRSA) and decolonize surgical patients of orthopedic, cardiothoracic and transplant procedures. If positive, decolonize 3 days before surgery with nasal mupirocin and chlorhexidine for 5 days in total. For patients known to be colonized with MRSA, it is reasonable to add a single preoperative dose of vancomycin to the recommended agent(s).
Duration of Prophylaxis
Recommendations for postoperative antimicrobial prophylaxis include either single-dose regimens or regimens with a duration of 24-48 hours postoperatively, depending on the procedure type and institutional protocols.
Reference: EDA (Egyptian Drug Authority) & UpToDate