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Prophylaxis of postoperative infections

Prophylaxe postoperativer Infektionen

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Summary

The antibiotic most appropriate for prophylaxis of postoperative infections depends on the nature of the operation. In aseptic (clean) operations, grampositive postoperative infections are the primary concern, and cefazolin is recommended because of its excellent pharmacokinetics and good activity against grampositive pathogens, including staphylococci. In those operations where violation of the digestive tract creates a contaminated field, a cefotaxime-generation cephalosporin is the agent of choice because of the excellent safety profiles and the capability of agents of this class to kill essentially all pathogenic gram-negative aerobes as well as a substantial portion of anaerobes. Selection of resistant bacteria has not been significant and is unlikely to become so with single-dose prophylaxis. Occasionally, if there is a high probability that the operative field may be heavily contaminated by anaerobes, metronidazole should be added. Dosing should be sufficient to cover the operative period. Only a single prophylactic dose is necessary, given at the time of induction of anesthesia. For particularly long operations, a second dose of those antibiotics with half-lives shorter than 60 min is required two hours after the first. Single-injection prophylaxis is effective, inexpensive, has no side effects and does not induce bacterial resistance.

Zusammenfassung

Die Art der Operation bestimmt die Wahl des besten Antibiotikums zur Prophylaxe post-operativer Infektionen. Infektionen nach aseptischen Operationen werden vorwiegend durch grampositive Bakterien verursacht, und wir empfehlen Cefazolin zur Prophylaxe, weil es gut grampositive Kokken, einschließlich der Staphylokokken, eliminiert und außerdem aus pharmakokinetischer Sicht hervorragend zur Prophylaxe geeignet ist. Bei Operationen mit Kontamination der Operationswunde durch Darmbakterien nach Magen-Darm-Eröffnung, sind Cephalosporine der Cefotaxim-Generation Mittel der Wahl, da sie alle wichtigen gramnegativen aeroben und wesentliche Teile der obligat anaeroben Bakterien erfassen und da mit der Einzeldosierung Nebenwirkungen äußerst selten sind. Die Selektion primär resistenter Bakterien durch die Einzeldosierung ist nicht beobachtet worden und unwahrscheinlich. Starke Kontamination des Operationsfeldes durch obligate Anaerobier erfordert die gleichzeitige Verabreichung von Metronidazol. Die Dosierung soll ausreichend sein, um genügend hohe Konzentrationen in der Operationswunde zu realisieren. Die bei Operationseinleitung verabreichte Einzeldosis hat die besten Resultate. Dauern die Operationen extrem lange, ist eine zweite Dosis zwei Stunden nach der ersten indiziert, falls das Antibiotikum eine kurze Eliminationshalbwertzeit von weniger als 60 Minuten hat. Die Einzeldosisprophylaxe ist wirksam, billig, hat keine Nebenwirkungen und induziert keine bakertielle Resistenz.

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References

  1. Miles, A. A., Miles, E. M., Burke, J. The value and duration of defense reactions of the skin to primary lodgment of bacteria. Br. J. Exp. Pathol. 38 (1957) 79–96.

    Google Scholar 

  2. Burke, J. F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 50 (1961) 161–168.

    Google Scholar 

  3. National Research Council Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann. Surg. 160 (Suppl. 1) (1964) 192.

    Google Scholar 

  4. Elek, S. D. Experimental staphylococcal infections in the skin of man. Ann. NY Acad. Sci. 65 (1956) 85–90.

    Google Scholar 

  5. Polk Jr., H. C., Lopez-Mayor, J. F. Postoperative wound infection: a postoperative study of determinant factors and prevention. Surgery 66 (1969) 97–103.

    Google Scholar 

  6. Stone, H. H., Hooper, A., Kolb, L. D., Geheber, C. E., Dawkins, E. J. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann. Surg. 184 (1976) 443–452.

    Google Scholar 

  7. Dübgen, R. Prophylaxis of infections with antibiotics in colorectal and gastroduodenal operations and appendectomies. A validation of clinical trials (German). Dissertation, Hamburg University Medical School. Hamburg, Germany, 1988.

    Google Scholar 

  8. Strachan, C. J. L., Black, J., Powis, S. J., Waterworth, T. A., Wise, R., Wilkinson, A. R., Burdon, D. W., Severn, M., Mitra, B., Norcott, H. Prophylactic use of cefazolin against sepsis after cholecystectomy. Br. Med. J. 1 (1977) 1254–1256.

    Google Scholar 

  9. Wittmann, D. H. Antibiotic concentration in tissue fluid during the vulnerable period as rational basis for prophylaxis of post operative infections: focus on infections after operations of the colon, biliary tree and bone. In:Ishigami, J. (ed.): Recent advances in chemotherapy. University of Tokyo Press, Tokyo 1985, pp. 189–192.

    Google Scholar 

  10. Nichols, R. L. Bowel preparation. In:Wilmore, D. W., Brennan, M. F., Harken, A. H., Holcroft, J. W., Meakins, J. L. (eds.): Care of the surgical patient. Volume 2. Scientific American, New York 1988.

    Google Scholar 

  11. Cainzos, M., Potel, J., Puente, J. L. Prospective randomized controlled study of prophylaxis with cefamandole in high risk patients undergoing operations upon the biliary tract. Surg. Gynecol. Obstet. 160 (1985) 27–32.

    Google Scholar 

  12. Bolufer, J. M., Armananzas, E., Puchades, F., Cervero, P., Trullenque, R., Cano, J. Profilaxis antibiotica en cirugia biliar electiva? Indicacion sistematica o electiva? Rev. Quir. Esp. 14 (1987) 323–327.

    Google Scholar 

  13. Halsall, A. K., Welsh, C. L., Craven, J. L., Hopton, D. W., Peel, R. N. Prophylactic use of metronidazole in preventing wound sepsis after elective cholecystectomy. Br. J. Surg. 67 (1980) 551–552.

    Google Scholar 

  14. Karran, S. J., Allen, S., Lewington, V. Cefuroxime prophylaxis in biliary surgery: In: International Congress and Symposium Series: Royal Society of Medicine. Academic Press, London, 20 (1981) 27–34.

    Google Scholar 

  15. Kaufman, Z., Dinbar, A. Single dose prophylaxis in elective cholecystectomy. Am. J. Surg. 152 (1986) 513–516.

    Google Scholar 

  16. Keighley, M. R. B., Baddeley, R. M., Burdon, D. W., Edwards, J. A. C., Quoraishi, A. H., Oates, G. D., Watts, G. T., Alexander-Williams, J. A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery. Br. J. Surg. 63 (1975) 275–279.

    Google Scholar 

  17. Kune, G. A., Hunt, R. F., Jed, A. Wound infection in elective biliary surgery. Controlled trial using one dose of cephamandole. Aust. NZ J. Surg. 55 (1985) 19–22.

    Google Scholar 

  18. Lewis, R. T., Goodall, R. G., Marien, B. Biliary bacteria, antibiotic use and wound infection in surgery of the gall bladder and common bile duct. Arch. Surg. 122 (1987) 44–47.

    Google Scholar 

  19. Morran, C., NcNaught, W., McArdle, C. S. Prophylactic cotrimoxazole in biliary surgery. Br. Med. J. 2 (1978) 462–464.

    Google Scholar 

  20. Morran, C. G., Thomson, G., White, A., NcNaught, W., Smith, D. C., McArdle, C. S. Wound sepsis after low risk elective cholecystectomy: the effect of cefuroxime. Br. J. Surg. 71 (1984) 540–542.

    Google Scholar 

  21. McArdle, C. S., Moran, C. G., Thomson, G., White, A., Pickard, R., NcNaught, W., Smith, D. C. Prophylactic use of cefuroxime in elective biliary surgery. Res. Clin. Forums 5 (1983) 65–68.

    Google Scholar 

  22. Sykes, D., Basu, P. K. Prophylactic use of cefotaxime in elective biliary surgery. J. Antimicrob. Chemother. 14 (1984) 237–239.

    Google Scholar 

  23. Elke, R., Widmer, M., Gerber, H., Trippel, M., Gruber, U. F. Single-dose of mezlocillin for antibiotic prophylaxis in biliary surgery. Eur. Surg. Res. 15 (1983) 101–106.

    Google Scholar 

  24. Lewis, R. T. Wound infection after gastroduodenal operations: a 10-year review. Can. J. Surg. 20 (1977) 435–440.

    Google Scholar 

  25. Drumm, J., Donovan, I. A., Wise, R. A comparison of cefotetan and cefazolin for prophylaxis against wound infection after elective cholecystectomy. J. Hosp. Infect. 6 (1985) 277–280.

    Google Scholar 

  26. Kellum, J. M., Duma, R. J., Gorbach, S. L., Sugarman, H. J., Haynes, B. W., Gervin, A., Newsome, H. H. Single-dose antibiotic prophylaxis for biliary surgery: cefazolin vs. moxalactam. Arch. Surg. 122 (1987) 918–922.

    Google Scholar 

  27. Hurlow, R. A., Streachan, C. J. L., Wise, R. A comparative study of the efficacy of cefuroxime for preventing wound sepsis after cholecystectomy. In: International Congress and Symposiums: Royal Society of Medicine. Academic Press, London 20 (1981) 1–8.

    Google Scholar 

  28. Kauffman, Z., Engelberg, M., Eliashav, A., Reiss, R. Systemic prophylactic antibiotics in elective biliary surgery. Arch. Surg. 119 (1984) 1002–1004.

    Google Scholar 

  29. Maki, D. G., Lammers, J. L., Aughey, D. R. Comparative studies of multiple dose cefoxitin vs. single dose cefonicid for surgical prophylaxis in patients undergoing biliary tract operations and hysterectomy. Rev. Infect. Dis. 6 (1984) S887-S895.

    Google Scholar 

  30. Prada, D., Garcia, S., Ortega, J. M., Jimenez, A., Garcia, S. Profilaxis antibiotica en cirugia biliar. Indicaciones y resultados. Rev. Esp. Enferm. Apar. Dig. 68 (1985) 111–116.

    Google Scholar 

  31. Roufail, W. M. Comparison of cefonicid and cefoxitin for prophylaxis in biliary tract surgery. Adv. Ther. 2 (1985) 225–232.

    Google Scholar 

  32. Morris, D. L., Mojadeddi, Z. J., Burdon, D. W., Keighley, M. R. B. clinical and microbiological evaluation of piperacillin in elective biliary surgery. J. Hosp. Infect. 4 (1983) 159–164.

    Google Scholar 

  33. Wilson, S. E., Hopkins, J. A., Williams, R. A. A comparison of cefotaxime versus cefamandole in prophylaxis for surgical treatment of the biliary tract. Surg. Gynecol. Obstet. 164 (1987) 207–212.

    Google Scholar 

  34. Wittmann, D. H., Koltowski, P., Oleszkiewicz, J., Walker, A. P. Infectious complications after 809 biliary tract operations and results of a randomized single blind study comparing cefoxitin versus ampicillin plus an inhibitor of beta-lactamases. Infection 18 (1990) 41–47.

    Google Scholar 

  35. Chester, J. F., Fergusson, C. M., Chant, A. D. The effect of cephradine prophylaxis on wound infection after arterial surgery through a groin incision. Ann. R. Coll. Surg. Engl. 65 (1983) 389–390.

    Google Scholar 

  36. Evans, C., Pollock, A. V. The reduction of surgical wound infections by prophylactic parenteral cephaloridine. A controlled clinical trial. Br. J. Surg. 60 (1973) 434–437.

    Google Scholar 

  37. Geroulanos, S., Oxelbark, S., Donfried, B. Antimicrobial prophylaxis in cardiovascular surgery. Thorac. Cardiovasc. Surg. 35 (1987) 199–205.

    Google Scholar 

  38. Kaiser, A. B., Clayson, K. R., Mulherin, J. L., Roach, A. C., Allen, T. R., Edwards, W. H., Dale, W. A.: Antibiotic prophylaxis in vascular surgery. Ann. Surg. (1978) 283–289.

  39. May, A. R. L., Darling, C., Brewster, D. C. A comparison of the use of cephalothin and oxacillin in vascular surgery. Arch. Surg. 115 (1980) 56–59.

    Google Scholar 

  40. Pitt, H. A., Postier, R. G., MacGowan, W. A. L. Prophylactic antibiotics in vascular surgery. Topical, systemic, or both? Ann. Surg. 192 (1980) 356–364.

    Google Scholar 

  41. Salzmann, G. Perioperative infection prophylaxis in vascular surgery — a randomized, prospective study. Thorac. Cardiovasc. Surg. 31 (1983) 239–242.

    Google Scholar 

  42. Wittmann, D. H., Garwig, J., Fliedner, E., Toenies, H.: Is antibiotic prophylaxis justified in clean operations? Results of a randomized double blind study in 374 neurosurgical operations. In: Abstracts of the 14th International Congress of Chemotherapy, Kyoto, Japan. International Society of Chemotherapy 1985, Abstract no. P-13-71, p. 313.

  43. Platt, R., Zaleznik, D. F., Hopkins, C. C., Dellinger, E. P., Karchmer, A. W., Bryan, C. S., Burke, J. F., Wikler, M. A., Marino, S. K., Holbrook, K. F., Tosteson, T. D., Segal, M. R. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. N. Engl. J. Med. 322 (1990) 153–160.

    Google Scholar 

  44. Garcia-Rodriguez, J. A., Puig-La Calle, J., Arnau, C., Porta, M., Vallvé, C. Antibiotic prophylaxis with cefotaxime in gastroduodenal and biliary surgery. Am. J. Surg. 158 (1989) 428–434.

    Google Scholar 

  45. Wittmann, D. H., Bergstein, J. M., Aprahamian, C., Küchlin, J.: Broad Spectrum coverage versus antistaphylococcal prophylaxis alone reduces bone infections after open fractures. Society for Academic Emergency Medicine, Annual Meeting 1990, Abstract no. 28.

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Authors and Affiliations

  1. Dept. of Surgery, Section of Trauma and Emergency Surgery, Medical College of Wisconsin, 8700 W. Wisconsin Ave., 53226, Milwaukee, WI, USA

    D. H. Wittmann M.D., Ph.D. & R. E. Condon M.D.

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  1. D. H. Wittmann M.D., Ph.D.
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  2. R. E. Condon M.D.
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See alsoAprahamian, C. andWittmann, D. H.: Operative management of intraabdominal infection. Infection 19 (1991) 453–455.

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Wittmann, D.H., Condon, R.E. Prophylaxis of postoperative infections. Infection 19 (Suppl 6), S337–S344 (1991). https://doi.org/10.1007/BF01715775

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