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Antibiotic prophylaxis in “clean” surgical procedures

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Abstract

The incidence of infection for clean surgical procedures should be less than 2%. The majority of infections are exogenous from Staphylococcus aureus.These exogenous sources of bacteria include the ward, the theater environment, medical personnel, bed linen, and other infected patients. Endogenous infections may arise from the patient's own nose and skin; and although the majority of bacteria are staphylococcal, gram-negative intestinal bacteria may colonize the skin around the perineum and are, therefore, important pathogens in hip replacement and aortobifemoral grafts. Methods of reducing exogenous infection include theater discipline, ultra clean air, surgical scrub, and isolating infected patients on the ward. Endogenous infections may be minimized by avoiding prolonged preoperative hospital stay, careful shaving only around the incision, and skin preparation with iodophors or chlorhexidine in alcohol. There is no place for antibiotic prophylaxis in clean surgical operations, provided the patient has a normal defense mechanism and provided a foreign body is not being implanted into bone or the circulation. Because of the morbidity and potential mortality of infected implants, antibiotics should be used in clean prosthetic surgery.

Résumé

Le taux d'infection chirurgicale ne soit pas dépasser 2% lorsqu'il s'agit d'interventions dites aseptiques. La cause la plus fréquente en est lestaphylococcus aureus. Les sources exogènes de l'infection se situent au niveau des salles d'hospitalisation des annexes du bloc opératoire, du personnel médical, du linge et des malades déjà infectés. Les sources endogènes sont représentées par la peau et les orifices naturels du patient lui même. Bien que dans la majorité des cas le staphylocoque soit en cause des germes grams négatifs situés au niveau de la région périnéale peuvent être à l'origine de l'infection chirurgicale, en particulier lors des arthroplasties de la hanche et des greffes aortobifémorales.

Pour réduire l'infection de cause exogène il convient d'observer une stricte discipline au niveau du bloc opératoire, de disposer d'air absolument pur, de respecter les règles d'asepsie avec rigueur et d'isoler tous les malades infectés. L'infection d'origine endogène peut être réduite en écourtant le séjour du malade à l'Hôpital avant l'intervention, en rasant soigneusement les téguments au niveau de la zone opératoire, en préparant la peau avec des solutions antiseptiques (solutés alcooliques d'iodophores ou de chlorexidine).

Il est inutile de donner des antibiotiques à titre préventif dès lors que l'intervention à entreprendre est considérée comme aseptique, que le malade en bon état général possède un bon système de défense, et que l'opération ne consiste pas en la pose d'une prothèse au niveau de la coxofémorale ou d'un greffon aorto-bi-iliaque.

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  1. Brighton General Hospital, Elm Grove, BN2 3EW, Brighton, England

    Colin Strachan M.D., F.R.C.S.(E)

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  1. Colin Strachan M.D., F.R.C.S.(E)
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Strachan, C. Antibiotic prophylaxis in “clean” surgical procedures. World J. Surg. 6, 273–280 (1982). https://doi.org/10.1007/BF01653542

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