Antibiotics in surgical patients

Abstract

You have asked… When should antibiotics be used to prevent surgical site infection (SSI)? The expert says… A ntibiotic use in surgical patients is aimed at preventing SSIs or treating known preexisting infections. In the latter case, antibiotic administration should follow general principles of appropriate antimicrobial therapy, which are beyond the scope of this article. 1 Antibiotic use is not innocuous, despite minimal adverse effects. Inappropriate antibiotic use can result in a high risk for therapeutic failure and emerging bacterial resistance, affecting both the patient and its environment. Because bacterial resistance is a major public health concern, veteri-nary professionals need to demonstrate responsibility and dedication to avoid antibiotic misuse or face limitations and loss of privilege in prescribing these drugs. It is, therefore, each veterinari-an's duty to critically review antibiotic use according to the best available evidence. The preliminary step in judicious antibiotic administration is to understand what can be expected from their use. SSI development depends on several factors: the amount and nature (virulence) of bacterial contamination, local conditions (wound), and susceptibility of the host (patient). Thus, prevention of SSI must be seen as a chain of factors, including patient condition, surgical preparation, antimicrobial administration strategy, potential for contamination in the surgical environment, and wound condition (depends on the quality of surgical technique). The strength of this chain is limited by its weakest link. Increasing the antibiotics administered (ie, type, dose, duration) to patients involved in excessively traumatic surgical procedures or when poor aseptic technique has been used will not necessarily lower the SSI rates but can favor bacte-rial resistance and clinical adverse effects. Similarly, using antibiotics locally within the peritoneal Antibiotic use is not