Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery. Antibiotic Prophylaxis in Hernia Repair and Breast Surgery: A Prospective Randomized Study Comparing Piperacillin/Tazobactam Versus Placebo Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis Risk factors for surgical-wound infection in general surgery: a prospective study. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. Clindamycin/cefonicid in head and neck oncologic surgery: one-day prophylaxis is as effective as a three-day schedule. Wound prophylaxis with metronidazole in head and neck surgical oncology. The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction. Antimicrobial prophylaxis for contaminated head and neck surgery. Comparison of three prophylactic antibiotic regimens in clean‐contaminated head and neck surgery [Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit?]. Subcutaneous application of gentamicin collagen implants as prophylaxis of surgical site infections in laparoscopic colorectal surgery: a randomized, double-blinded, three-arm trial [Antibiotic prophylaxis in breast surgery. Preliminary resuls of a multicenter randomized study on 1400 cases]. Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection. A new approach to the problem of surgical wound infections in clean operations. A comparison between amoxycillin/clavulanate and mezlocillin in abdominal surgical prophylaxis. [Cost effectiveness of preventive antibiotic administration for lowering risk of infection by 0.25%]. Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study. A Randomized, Double-blinded Placebo-controlled Clinical Trial of the Routine Use of Preoperative Antibiotic Prophylaxis in Modified Radical Mastectomy Efficacy of two third-generation cephalosporins in prophylaxis for head and neck surgery. Ceftriaxone vs. ampicillin + metronidazole as prophylaxis against infections after clean-contaminated abdominal surgery. Antibiotic Pharmacodynamics in Surgical Prophylaxis: an Association between Intraoperative Antibiotic Concentrations and Efficacy A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries
BACKGROUND Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime . OBJECTIVE To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis . PATIENTS AND METHODS In this prospect i ve , double-blind clinical trial , 189 patients with carcinoma of the upper aerodigestive tract were r and omized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses . RESULTS An overall wound infection rate of 22 % was observed . The infection rate in patients receiving cefazolin was 24 % ( 22/92 ) vs. 21 % ( 20/97 ) in those receiving amoxicillin-clavulanate ; the difference was not statistically significant . Postoperative overall non-wound infection developed in 12 % ( 22/189 ) patients ; the rate of infection was 9.8 % ( 9/92 ) in patients receiving cefazolin vs. 13.4 % ( 13/97 ) in those receiving amoxicillin-clavulanate , without a statistically significant difference between the two groups . Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species . The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage . CONCLUSION In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin . However , when taking into account the fact that beta-lactamase containing strains have recently been spreading , amoxicillin-clavulanate should be the logical first choice Abstract Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery , its use for these clean procedures is widely adopted , albeit to a different extent in different countries , often on the personal decision of the individual surgeon . The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery . A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospect i ve r and omized clinical study . Patients were r and omly assigned to receive preoperative antibiotic prophylaxis or placebo . One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v . 30 minutes prior to the surgical procedure . Using statistical univariate analysis , the following variables were correlated with a higher infection risk :  age > 40 years , concomitant disease , WBC < 3500 , surgical wound size > 9 cm , use of drainages , non-prophylaxis . Using multivariate analysis , no antibiotic pre-operative prophylaxis , concurrent chronic diseases , especially diabetes ( risk 15 times higher ) , and length of intervention > 45 min ( risk 6 times higher ) were independent predictors of infection . Finally , patients with postoperative infections  had a significantly longer hospitalisation . One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair Objective To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for  surgical-site infections and remote infections such as respiratory tract infections ( RTIs ) and urinary tract infections ( UTIs ) . Methods The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local ( surgical wound ) and remote ( RTIs and UTIs ) infections  in a meta- analysis of r and omised controlled trials published between 1984 and 2003 . The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies . Results Evaluations were performed on 48 studies , for a total of 17 565 patients . Overall , 406 patients ( 4.8 % ) in the ceftriaxone group and 525 ( 6.3 % ) in the comparator group developed a surgical-site infection ( log odds ratio [ OR ] −0.30 [ CI −0.50 to −0.13 ] ; p < 0.0001 ) . RTIs were observed in 292 ( 6.01 % ) patients in the ceftriaxone group and in 369 ( 7.6 % ) patients in the comparator group , ( log OR −0.30 [ CI −0.55 to −0.09 ] ; p = 0.0013 ) . UTIs were reported for 2.2 % of the ceftriaxone prophylaxis patients compared with 3.74 % of the comparator group patients ( log OR −0.54 [ CI −1.18 to −0.16 ] ; p < 0.0001 ) . Overall , in clean surgery 195 ( 5.1 % ) and 234 ( 6.2 % ) patients developed a surgical site infection in the ceftriaxone and comparator groups , respectively ( log OR −0.22 [ CI −0.51 to 0.01 ] ; p = 0.0476 ) . RTIs were prevented for all but 1.57 % of patients in the ceftriaxone group and 2.62 % of patients in the comparator group ( p = 0.01 ) in clean surgery , and for 9.54 % of the ceftriaxone group versus 11.6 % of the comparator group ( p = 0.01 ) in clean-contaminated surgery . While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence ( log OR −0.21 [ CI 0.0–0.65 ] ; p = 0.7702 ) , this was clearly shown in the clean-contaminated surgery . In fact , 4.47 % of patients in the ceftriaxone group versus 7.52 % of patients in the comparator group developed a UTI ( log OR −0.56 [ CI −1.25 to −0.16 ] ; p < 0.0001 ) . Adverse events were observed in a similar proportion in the ceftriaxone prophylaxis and the comparator groups ( 0.35 % and 0.23 % , respectively ) . Duration of prophylaxis did not influence outcome of infection . Conclusions The meta- analysis showed that ceftriaxone is statistically superior to other antibiotics in preventing both local and remote postoperative infections OBJECTIVE To quantify surgical-infection rate , to assess adherence with the antibiotic prophylaxis protocol , and to identify independent factors associated with surgical-wound infection ( SWI ) . METHODS We carried out a prospect i ve study of a cohort of 2,237 general surgery patients with postsurgery stays of more than 48 hours .  Odds ratios ( OR ) were estimated using unconditional multiple logistic regression . SETTING A 1,300-bed , university-affiliated , tertiary-care hospital in Madrid , Spain . RESULTS 254 patients developed SWI .  The rate of adherence to the antibiotic prophylaxis protocol  was 63.5 % . Eight factors were independently associated with risk of SWI : age ( OR = 1.2 for every 10 years of age ) ; wound classification ( clean-contaminated , OR = 6.4 ; contaminated , OR = 3.7 ; dirty or infected , OR = 9.3 ) ; antimicrobial prophylaxis ( OR = 0.5 ) ; stay prior to surgery ( OR = 1.1 for every 3 days ) ; duration of operation ( OR = 1.5 for every 60 minutes ) ; malignant neoplasm ( OR = 1.7 ) ; emergency procedure ( OR = 1.99 ) ; intensive-care unit stay prior to surgery ( OR = 2.6 ) ; and antimicrobial prophylaxis administered 2 or more hours before operation ( OR = 5.3 ) . CONCLUSION In general , antimicrobial prophylaxis protects against SWI ( OR = 0.5 ) ; however , administration 2 hours or more before the operation increases the risk of SWI by a factor of 5.3 . Therefore , measures should be taken to ensure the correct timing of antimicrobial prophylaxis BACKGROUND R and omized , controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections . However , it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice . METHODS We prospect ively monitored the timing of antibiotic prophylaxis and studied the occurrence of surgical-wound infections in 2847 patients undergoing elective clean or " clean-contaminated " surgical procedures at a large community hospital . The administration of antibiotics 2 to 24 hours before the surgical incision was defined as early ; that during the 2 hours before the incision , as preoperative ; that during the 3 hours after the incision , as perioperative ; and that more than 3 but less than 24 hours after the incision , as postoperative . RESULTS Of the 1708 patients who received the prophylactic antibiotics preoperatively , 10 ( 0.6 percent ) subsequently had surgical-wound infections . Of the 282 patients who received the antibiotics perioperatively , 4 ( 1.4 percent ) had such infections ( P = 0.12 ; relative risk as compared with the preoperatively treated group , 2.4 ; 95 percent confidence interval , 0.9 to 7.9 ) . Of 488 patients who received the antibiotics postoperatively , 16 ( 3.3 percent ) had wound infections ( P less than 0.0001 ; relative risk , 5.8 ; 95 percent confidence interval , 2.6 to 12.3 ) . Finally , of 369 patients who had antibiotics administered early , 14 ( 3.8 percent ) had wound infections ( P less than 0.0001 ; relative risk , 6.7 ; 95 percent confidence interval , 2.9 to 14.7 ) . Stepwise logistic-regression analysis confirmed that the administration of antibiotics in the preoperative period was associated with the lowest risk of surgical-wound infection . CONCLUSIONS We conclude that in surgical practice there is considerable variation in the timing of prophylactic administration of antibiotics and that administration in the two hours before surgery reduces the risk of wound infection The aim of our study was to evaluate the optimal duration of antibiotic prophylaxis in major oncologic surgery of the head and neck using a novel broad spectrum drug combination : clindamycin and cefonicid . A prospect i ve r and omized study was carried out on 126 evaluable patients undergoing clean-contaminated ( skin to mucosa ) surgery for cancer of larynx , pharynx or oral cavity . Cases at high surgical risk ( because of need of pedicled or microvascular free flaps reconstruction ) , were excluded from the study . Within 20 days after surgery , only one case of wound infection was recorded among the 62 patients treated with the one-day schedule , versus three cases registered among the 64 subjects receiving three-day chemoprophylaxis . Episodes of systemic infections and eventual wound complications occurring in the first 20 days after surgery have also been recorded . The role of potential risk factors for postoperative complications has been evaluated . According to our findings , a three-day antibiotic regimen is not more effective than a short-term ( one-day ) schedule in preventing wound or systemic infection in clean-contaminated head and neck cancer surgery without flap reconstruction Anaerobic organisms are thought to be an important source of wound infection in head and neck oncologic surgery .  Antibiotic prophylaxis consisting of agents specific for anaerobes combined with broad-spectrum agents that provide coverage for other well-recognized pathogens should be an effective combination regimen for this group of patients . We conducted a prospect i ve , r and omized study comparing the efficacy of prophylaxis using combination of metronidazole and cefazolin- design ated group A , to prophylaxis using cefazolin alone-group B , for patients undergoing oncologic procedures of the head and neck . The rate of wound infection in the  cefazolin-metronidazole group ( 158 patients ) was 9.5 % , compared with 18.6 % in the cefazolin group ( 172 patients ) ( p = 0.03 ) . Patients undergoing clean procedures had a 4.9 % infection rate overall , compared with 17.9 % for clean-contaminated procedures , and 33.3 % for contaminated procedures . The average length of hospitalization was 20.7 days for patients who developed infections , compared with 8.9 days for patients without infection . Anaerobic organisms were cultured in 12 of 26 patients , ten of whom did not receive metronidazole . The lower rate of wound infection among patients who received metronidazole suggests that anaerobic organisms are an important source of wound infection in head and neck oncologic surgery . Chemoprophylaxis for these patients should , therefore , include specific anaerobic coverage in addition to the broad-spectrum agents that cover the more familiar aerobic organisms OBJECTIVES /HYPOTHESIS Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20 % to 25 % with parenteral antibiotic prophylaxis . Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections . We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high-risk patients . STUDY DESIGN We performed a r and omized , prospect i ve clinical trial . METHODS Patients received either 1 ) parenteral piperacillin/tazobactam ( 3.375 g every 6 hours for 48 h ) or 2 ) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively , with piperacillin/tazobactam added to the intraoperative irrigation solution . The wounds of all patients were evaluated daily using predefined objective criteria . RESULTS Sixty-two patients met inclusion criteria and were enrolled in the study . The overall wound infection rate was 8.1 % ( 95 % confidence interval [ CI ] , 2.7%-17.8 % ) . Two of 31 patients ( 6.4 % ) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients ( 9.7 % ) r and omly assigned to receive topical plus parenteral antibiotics . This difference was not statistically significant ( P = > .05 ) . Infection rate was not associated with flap type ( rotational vs. free tissue transfer ) , m and ibular reconstruction , age , gender , tumor site , stage , surgical duration , or blood loss . CONCLUSIONS These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery . However , the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone The use of antibiotic prophylaxis in head and neck surgery is controversial . Most surgeons agree that when surgery requires entry into the aerodigestive tract through the skin the wound is by definition contaminated and antibiotic prophylaxis is indicated as it is in other contaminated wounds . There is no general agreement as to which antibiotic or combination of antibiotics to use or what the schedule of dosage administration should be . In order to obtain a meaningful data to help in decision making , a double blind , r and omized study was performed to investigate whether cefazolin alone or a combination of gentamicin and clindamycin was more effective in prophylaxis . All patients entered into the study underwent major oncologic head and neck surgery requiring entry into the upper aerodigestive tract through the skin . Patients were stratified at entry according to the stage of disease , surgical procedure , and the existence of a prior tracheotomy or prior radiation therapy . Subsequently , patients were r and omly assigned to 1 of 4 treatment groups . Group I : Cefazolin 1 day , placebo day 2 to 5 . Group II : Cefazolin days 1 to 5 , Group III : Gentamicin and clindamycin 1 day , placebo days 2 to 5 . Group IV : Gentamicin and clindamycin days 1 to 5 . Drugs were given intravenously beginning 3 hours preoperatively and continued postoperatively every 8 hours , according to the assigned schedule . All wounds were observed daily following surgery and were grade d on a predetermined scale by 3 unbiased observers . Significantly wound infections occurred in 15 % of all patients . Group I , 33 % ; Group II , 20 % ; Group III , 7 % ; Group IV , 4 % . In Group III and Group IV there was a statistically significant ( P less than .05 ) reduction in the rate of postoperative wound infection . Multifactorial analysis demonstrated that patients whose surgery included repair with a regional pectoral flap had a statistically significant increased chance of developing postoperative wound infection ( P less than .05 ) . Patients undergoing laryngectomy , with or without neck dissection , were at less risk of postoperative infection tham patients undergoing oropharyngeal resection ( P less than .05 ) . The preoperative existence of tracheotomy or prior radiation therapy had no demonstrable effect on the incidence of wound infection postoperatively in this study Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean‐contaminated head and neck surgical procedures , controversy still remains regarding the optimal antibiotic regimen BACKGROUND Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery . In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality . Inguinal hernia repair is a clean operation , infections are rare ; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh . Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia , compared to those treated with prophylaxis . METHODS One hundred and forty-eight patients underwent inguinal hernia repair with mesh : 64 patients ( 43 % ) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation , 84 patients ( 57 % ) did not receive any antimicrobic prophylaxis . Mean follow-up was 13 months ( range 1 - 31 months ) for both groups . RESULTS We did not observe any major complication . Among both groups , no patient had developed infection at one week and one month after surgery . CONCLUSIONS In personal experience , any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed . A review of the literature showed no general agreement on this subject with different risk of infections in different trials . A new prospect i ve r and omized trial is necessary to clarify this topic Purpose Despite a st and ardized prophylaxis with antibiotics , surgical site infections ( SSI ) are a characteristic problem in colorectal surgery . Local administration of gentamicin-collagen sponges ( GCS ) has been shown to decrease the infection rate after contaminated procedures . So far , the effect has not been tested for st and ardized laparoscopic colorectal resections . Methods We conducted a r and omized , double-blind , placebo-controlled trial to investigate the efficacy of GCS to reduce wound infection after laparoscopic colorectal resections . Patients underwent a st and ardized operative procedure with st and ardized incision treatment . The intervention was the application of a GCS in the subcutaneous tissue of the bowel extraction site ( GCS group ) . In the collagen group , a collagen sponge without antibiotics was used , and no sponge was used in the control group . The primary endpoint was SSI within 30 days postoperatively , according to the Center of Disease Control and Prevention definition . Results We r and omly assigned 291 patients to all three groups . There was no difference between the groups regarding demographic characteristics and perioperative course . SSI was diagnosed in 8.2 % ( GCS group ) , 13.5 % ( collagen group ) , and 11.3 % ( control group ) of patients . No significant difference was found among the groups . Conclusion The local administration of GCS showed no significant benefit regarding wound infection after st and ardized laparoscopic colorectal resections . However , there was a trend toward reduced SSI in the GCS group . Therefore , a larger trial or meta- analysis is necessary to vali date this result UNLABELLED Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection ( 3 - 15 % ) . The objective of this study was to evaluate the advantages antibiotic prophylaxis  in patients undergoing breast surgery .  A multicenter r and omized controlled study was performed between January 2008 and November 2008 . One thous and four hundred patients were enrolled in prospect i ve r and omized study ; surgical wound infection was found in 41 patients ( 2.93 % ) . In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection ( 17 patients , 2.42 % , subjected to antibiotic prophylaxis vs 24 patients , 3.43 % , without antibiotic prophylaxis ) ( P = 0.27 ) . In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis ( 5 patients , 0.92 % , subjected to antibiotic prophylaxis vs 14 patients , 3.09 % , without antibiotic prophylaxis ) ( P = 0.02 ) . CONCLUSION This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant OBJECTIVE To compare the rate of surgical site infection ( SSI )  before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented . To demonstrate that a more prudent , restrictive policy would not have a detrimental effect on patient outcomes . DESIGN Before-after trial with prospect i ve SSI surveillance in the Dutch nosocomial surveillance network ( Preventie Ziekenhuisinfecties door Surveillance [ PREZIES ] ) , using the criteria of the Centers for Disease Control , including postdischarge surveillance for up to 1 year . METHODS During a preintervention period and a postintervention period ( both 6 - 13 months ) , 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates . The study was limited to commonly performed surgical procedures in 4 specialties : vascular , intestinal , gynecological and orthopedic surgery . Selected risk factors for analysis were sex , age , American Society of Anesthesiologists classification , wound contamination class , duration of surgery , length of hospital stay before surgery , and urgency of surgery ( elective or acute ) . RESULTS A total of 3,621 procedures were included in the study , of which 1,668 were performed before the intervention and 1,953 after . The overall SSI rate decreased from 5.4 % to 4.5 % ( P=.22 ) . Among the procedures included in the study , the largest proportion ( 55 % ) were total hip arthroplasty , and the smallest proportion ( 2 % ) were replacement of the head of the femur . SSI rates varied from 0 % for vaginal hysterectomy to 21.1 % for femoropopliteal or femorotibial bypass surgery . Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention ( P>.1 ) . CONCLUSIONS An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery , as measured by SSI rate A study was made of the risk factors causing a high incidence of  surgical wound infections in clean operations . Identification of these factors in the preoperative stage allows the patients to be divided into two categories : a high risk ( about 10 % of patients for surgery ) and low risk . By giving antibiotic prophylaxis only to patients at high risk , the incidence of postoperative infections can be reduced , decreasing the number of extra days in hospital and consequently lowering costs . This is a new approach to the problem of surgical wound infections since not only is it based on the usual classification of operations into clean , clean-contaminated , contaminated and dirty , but it also takes into account the defensive capacity of the target of the infection : the patient A r and omized comparative study was conducted to evaluate the clinical efficacy of amoxycillin/clavulanate ( Augmentin ) compared with mezlocillin for the prevention of wound infection in patients undergoing abdominal surgery . There was no difference in overall wound infection rates between the amoxycillin/clavulanate treated group and the mezlocillin group . When sub-groups were examined for total infections no significant difference was seen between antibiotic groups in patients undergoing clean/potentially contaminated operations or contaminated operations , although more deep infections were encountered in the amoxycillin/clavulanate group in comparison with the mezlocillin group , in contaminated operations . The type of operation performed also failed to show any difference in those patients undergoing upper gastro-intestinal , appendiceal , colonic , or biliary operations . The infections in those receiving amoxycillin/clavulanate were largely of bowel origin and predominantly sensitive to  amoxycillin/clavulanate . Those in the mezlocillin group were predominantly staphylococcal in origin . Amoxycillin/clavulanate appears to be an effective antibiotic for use as a single agent in surgical prophylaxis Antibiotic prophylaxis in closed fractures is cost-effective if the risk of a deep infection is reduced by 0.25 % . This control study was undertaken to assess the cost-effectiveness of prophylaxis of postoperative infections after surgical  treatment of closed fractures . The costs for 16 patients with infections ( 8 with deep infections , 8 with superficial infections ) were investigated and compared with the costs for 16 similar but non-infected patients with special reference to length of hospital stay , antibiotics and surgery . The data were collected from the trauma department of the University Hospital of the Free University in Amsterdam .  Costs in the group of 8 patients with superficial wound infection were not substantially higher than those for their non-infected controls . The occurrence of a deep infection meant costs an average of DFL 35,224 higher than an uneventful postoperative course . On the basis of these results , antibiotic prophylaxis of postoperative wound infections is cost-effective if it reduces the risk of deep wound infections by about 0.25 % OBJECTIVE --To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a st and ard three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery . DESIGN -- Prospect i ve r and omised allocation to one of two prophylactic antibiotic regimens in a parallel group trial . Group sequential analyses of each 250 patients were performed . SETTING --14 District general and teaching hospitals . PATIENTS --1018 Adults having colorectal operations were r and omised , of whom 943 were evaluated . Demographic features , conditions requiring surgery , and operative procedures were similar in the two groups . Most patients had surgery for carcinoma of the colon or rectum . INTERVENTIONS --Group 1 received cefotaxime 1 g intravenously plus metronidazole 500 mg intravenously preoperatively . Group 2 received cefuroxime 1.5 g intravenously plus metronidazole 500 mg intravenously preoperatively , followed by cefuroxime 750 mg intravenously plus metronidazole 500 mg intravenously eight hours and 16 hours postoperatively . MAIN OUTCOME MEASURES --Development of surgical wound infection ( as evidence d by the presence of pus ) , death , or discharge from hospital . RESULTS --Wound condition was scored on a five point scale on alternate days until discharge or for up to 20 days postoperatively . Wound infection rates were : group 1 , 32/453 ( 7.1 % ; 95 % confidence interval 4.7 % to 9.4 % ) ; group 2 , 33/454 ( 7.3 % ; 95 % confidence interval 4.9 % to 9.6 % ) . Death rates ( group 1 : 26/470 ( 5.5 % ) ; group 2 : 31/471 ( 6.6 % ] , the incidence of postoperative complications , the median duration of hospital stay ( 12 days ) , and antibiotic tolerance were all similar in the two groups . Pooled data from groups 1 and 2 showed that wound infections were more frequent when minor faecal contamination had occurred at operation and when the duration of operation exceeded 90 minutes ( greater than 90 min 11.2 % of cases ; less than 90 min 4.8 % ) and were associated with an extended hospital stay . CONCLUSIONS --A single preoperative dose of cefotaxime plus metronidazole is an efficacious as a three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery and has practical advantages in eliminating the need for postoperative antibiotics Background The effectiveness of antibiotic prophylaxis for prevention of surgical site infection ( SSI ) following specific types of breast cancer surgery remains uncertain . This study assessed the effectiveness of prophylaxis in modified radical mastectomy  ( MRM ) . Methods Women undergoing MRM for breast cancer were recruited . Women were excluded who had diabetes mellitus , severe malnutrition or known allergy to cephalosporins ; were receiving corticosteroid therapy or were treated with antibiotics within one week prior to surgery ; were scheduled for simultaneous breast reconstruction or bilateral oophorectomy ; had existing local infection . Participants were r and omized to receive either intravenous cefazolin 1 g or placebo within 30 min prior to skin incision . St and ard skin preparation and operative technique for MRM were carried out . Wounds were assessed for SSI and other complications weekly for 30 days . Results A total of 254 women were recruited . Age , clinical stage , prior chemotherapy , and operative time were similar for antibiotic and placebo groups . The overall incidence of SSI was 14.2 % . There were no significant differences in the infection rate over the 30-day follow-up period between the placebo and antibiotic groups ( 15 % vs 13.4 % ; p = 0.719 ) or at each week . The majority of SSI were either cellulitis or superficial infection for both groups . There were no significant differences between groups in treatments required for SSI , incidence of hematoma or seroma . Conclusions The findings of this study , alone and when meta-analyzed with data from studies in similar surgical population s , do not support the use of antibiotic prophylaxis in MRM Optimal antimicrobial prophylaxis during head and neck surgery is as yet unclear . The semisynthetic third-generation cephalosporin antibiotics would appear to have potential usefulness because of their broad antibacterial spectrum , favorable pharmacokinetic properties , and record of safety . Eighty patients were prospect ively r and omized into this placebo-controlled , double-blind study to receive either placebo , cefoperazone sodium , or cefotaxime sodium preoperatively and for 24 hours postoperatively . Infection rates were 78 % for the placebo group and 10 % for the group receiving the cephalosporin antibiotics .  Infections were polymicrobial . Anaerobic bacteria constituted 42 % of the pathogens isolated . Wound and serum antibiotic concentrations exceeded the minimal inhibitory concentration of the bacterial flora . This study establishes the necessity of antimicrobial prophylaxis for contaminated oncologic procedures of the head and neck . Our experience indicates that cefoperazone and cefotaxime are particularly useful In a prospect i ve , controlled , double-blind study , 496 patients undergoing abdominal surgery were given antibiotic prophylaxis with a single dose of either ceftriaxone or ampicillin + metronidazole . No significant intergroup difference was found between the respective overall rates of infectious complications ( 3.2 % and 4.9 % ) . Analysis of the microbiologic findings showed incisional wound infections , mainly caused by gram-negative rods , to be more common in the ampicillin-metronidazole group , whereas deep wound infections were more frequent in the ceftriaxone group . It is concluded that ceftriaxone seems to be more efficient than ampicillin-metronidazole as prophylaxis against incisional wound infection , but should preferably be supplemented with an antianaerobic agent to prevent deep wound infections ABSTRACT The objective of this study was to characterize the relationship between gentamicin concentrations during surgery and the development of wound infection following colorectal operations . Despite decades of research in surgical prophylaxis , the relationship between intraoperative antibiotic concentrations and postoperative infection and the concentrations required for effective prophylaxis have not been established . A pharmacodynamic analysis was conducted using data from a previous prospect i ve , r and omized , double-blind clinical study which compared two dosage regimens of gentamicin plus metronidazole for prophylaxis in connection with elective colorectal surgery . Univariate and multivariate analyses of risk factors for postoperative wound infection were conducted , and the relationship between intraoperative gentamicin concentrations and surgical outcome was characterized . The gentamicin concentration at the time of surgical closure was one of the strongest independent risk factors for infection ( P = 0.02 ) , along with the presence of diabetes mellitus ( P = 0.02 ) , stoma ( P = 0.04 ) , and advanced age ( P = 0.05 ) . Gentamicin concentrations at closure of less than 0.5 mg/liter were associated with an infection rate of 80 % ( representing 8 of 10 patients with concentrations below that level ) ( P = 0.003 ) . Receiver operating characteristic curve analysis identified a critical closure concentration of 1.6 mg/liter for effective surgical prophylaxis ( P = 0.002 ; sensitivity , 70.8 % ; specificity , 65.9 % ) . This study provides new and important information on antibiotic pharmacodynamics in surgical prophylaxis . It demonstrates the critical effect of the antibiotic concentration at closure on wound infection and suggests a significant association between the concentration and other well-established risk factors , like the timing of preoperative antibiotic administration and surgery duration BACKGROUND : Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections . OBJECTIVE : This study aim ed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation for preventing surgical site infections in clean contaminated , contaminated , and dirty colorectal procedures . DESIGN : This was a single-center , prospect i ve r and omized study . SETTING : This study was conducted at the General Surgery Department at Jinling Hospital , Nanjing University , China , from July 15 , 2014 to January 20 , 2016 . PATIENTS : Patients aged ≥18 years scheduled for abdominal surgery with clean-contaminated , contaminated , and dirty wounds were selected . INTERVENTIONS : Patients were r and omly assigned to receive preoperative mechanical bowel preparation or mechanical bowel preparation with oral antibiotics . MAIN OUTCOMES : The primary outcome was the rate of surgical site infections . The secondary outcomes were extra-abdominal complications , duration of postoperative ileus , and readmission rate . RESULTS : Ninety-five patients were allocated to each group . Eight and 26 surgical site infections ( 8.42 % vs 27.3 % , p = 0.004 ) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups . Thirteen extra-abdominal complications were reported : 6 in the mechanical bowel preparation with oral antibiotics group and 7 in the mechanical bowel preparation group ( 6.3 % vs 7.3 % , p = 0.77 ) . Postoperative ileus duration did not differ between groups ( p = 0.23 ) . There were 4 readmissions in the mechanical bowel preparation group and none in the mechanical bowel preparation with oral antibiotics group ( p = 0.04 ) . On multivariable analysis , blood loss ≥500 mL ( OR , 5.1 ; 95 % CI , 1.27–20.4 ; p = 0.02 ) , ASA score ≥3 ( OR , 3.9 ; 95 % CI , 1.2–12.5 ; p = 0.01 ) , contaminated types ( OR , 3.6 ; 95 % CI , 1.5–8.6 ; p = 0.01 ) , and administration of preoperative oral antibiotics ( OR , 0.20 ; 95 % CI , 0.06–0.60 ; p = 0.005 ) independently affected the incidence of surgical site infections . LIMITATIONS : This was a single-center study . CONCLUSION : Preoperative oral antibiotics , as adjunct therapy to systemic antibiotics and mechanical bowel preparation , significantly reduced surgical site infections and minimized the readmission rates in clean contaminated , contaminated , and dirty  types of colorectal surgery .  See Video Abstract at http://links.lww.com/DCR/A437
However , there was no real evidence supporting the second hypothesis that the relative risk of wound infection would substantially vary over different levels of surgery cleanliness .
: As well as antibiotic prophylaxis being a generally effective intervention for preventing postoperative wound infection , the level of this effectiveness would appear to be reasonably independent of what type of surgery is being considered .
In particular , perhaps a sensible philosophy would be to assume that antibiotic prophylaxis is effective in reducing the risk of wound infection for all types of surgery , even ones where no clinical trial data exists and make exceptions to this rule if , for certain types of surgery , it can be proved to the contrary
CONTEXT While the main focus of a meta- analysis is often to assess the effectiveness of a particular intervention in managing or curing a specific condition , there exists a substantial amount of information within published systematic review s that could be used to assess the validity of a generic hypothesis about the effectiveness of an intervention across a range of different but related conditions .
OBJECTIVE To systematic ally search for and then collate the results of meta-analyses for the effectiveness of antibiotic prophylaxis in preventing postoperative wound infection across various types of surgery in order to assess generic hypotheses about the effectiveness of this intervention in surgery as a whole .
With the relative risk of wound infection used as the measure of clinical effectiveness , the hypotheses to be assessed were first that antibiotic prophylaxis would be an effective intervention for preventing wound infection over a broad range of different surgical procedures , and second that there would be a substantial difference in the effectiveness of antibiotic prophylaxis between " clean " and " contaminated " surgical procedures .