The Rationale Use of Antimicrobials in Septic Surgical Patients

Abstract

The choice of the antibiotic is influenced by multiple factors such as patient’s comorbidities and intolerance, the usual pathogens involved in the site of infection and the local resistance patterns. The physiological changes produced by surgery, burns, trauma, septic shock, and hypoalbuminemia can influence the volume of distribution and the pharmacokinetic of the antimicrobial agents, and must be taken in account when choosing the appropriate antibiotic therapy. Culture tests are equally crucial in decision making process but the interpretation of the results is challenging and physicians should become familiar with some basic concepts such as MIC and antibiotic breakpoint. In order to improve the management of infections and antibiotics use, many international societies and local institutions have developed antibiotic stewardship programs (ASP). They promote the correct use of antimicrobials, the diffusion of protocols, and the improvement of infection management in hospital settings. One of the founding characteristic of ASP is the multidisciplinarity, and surgeons’ involvement is paramount. Surgical site infections (SSI) are infections that occur within 30 days from a surgical procedure or within 90 days from a permanent implant placement. They are common healthcare-associated infections (HAI) and represent a burden in terms of mortality, length of stay, and costs. Many efforts have been made to address SSI and the use of antibiotic prophylaxis has proven to be effective in most of the cases. Invasive fungal infections (IFI) are becoming a relevant cause of morbidity and mortality among surgical patients. Clinicians are more accustomed to antibiotics rather than antimycotic drugs and cooperation with specialists in infectious disease and microbiology is often required.