Summary
Background
Although guidelines for antibiotic prophylaxis to prevent surgical site infections
(SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency
towards excessive administration of antibiotics.
A total of 1100 patients were prospectively studied according to an evidence-based
protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does
increase the infection rate.
Methods
Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive
or cosmetic procedures were enrolled.
Procedures were classified into four groups, and prophylactic antibiotics were only
administered perioperatively in 23.4% of cases, according to patient-related and procedure-related
risk factors.
Results
The overall SSI incidence was 1.4% (1.1% for clean surgery and 3.8% for clean-contaminated
surgery). Oral oncologic surgery showed the highest infection rate (5.3%).
Conclusions
Specific guidelines are provided to encourage judicious use of antibiotics.
Antibiotic prophylaxis is administered based on the type of operation and the patient’s
characteristics. No prophylaxis was carried out in superficial skin surgery and simple
mucosal excisions.
Antibiotic prophylaxis is always indicated in microsurgery, prosthetic surgery, incisional
hernias, clean non-prosthetic osteoarticular surgery and clean-contaminated procedures
such as oral cavity or genitourinary system.
In clean surgery and rhinoplasty, antibiotic prophylaxis is only indicated when the
operation lasts more than 3 h and/or the American Society of Anesthesiologists (ASA)
score is 3 or more.
With the protocol reported, the risk of infection can be kept very low, avoiding the
negative effects of indiscriminate use of antibiotics.
Keywords
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Article info
Publication history
Published online: December 06, 2011
Accepted:
November 10,
2011
Received:
June 25,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
