Surgical antibiotic prophylaxis practice became common in the 1970s and has since become almost universal. The earliest articles used three doses over 12 hours with the first being administered before the start of the operation.
Conclusions:
The duration of prophylaxis has varied widely in practice over time, but an increasing body of evidence has supported shorter durations, most recently with recommendations in influential guidelines to avoid administration after the incision is closed.
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References
1.
PolkHC Jr, Lopez-MayorJF. Postoperative wound infection: A prospective study of determinant factors and prevention. Surgery, 1969; 66(1):97–103.
2.
BurkeJF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery, 1961; 50:161–168.
3.
MorranC, McNaughtW, McArdleCS. Prophylactic co-trimoxazole in biliary surgery. Br Med J, 1978; 2(6135):462–464; doi: 10.1136/bmj.2.6135.462
4.
MitchellNJ, EvansDS, PollockD. Pre-operation single-dose cefuroxime antimicrobial prophylaxis with and without metronidazole in elective gastrointestinal surgery. J Antimicrob Chemother, 1980; 6(3):393–399; doi: 10.1093/jac/6.3.393
5.
GeraghtyJ, FeelyM. Antibiotic prophylaxis in neurosurgery. A randomized controlled trial. J Neurosurg, 1984; 60(4):724–726; doi: 10.3171/jns.1984.60.4.0724
6.
LewisRT, AllanCM, GoodallRG, et al.A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery. Can J Surg, 1984; 27(1):44–47.
7.
MorranCG, ThomsonG, WhiteA, et al.Wound sepsis after low risk elective cholecystectomy: The effect of cefuroxime. Br J Surg, 1984; 71(7):540–542; doi: 10.1002/bjs.1800710724
8.
KuneGA, HuntRF, JedA, et al.Wound infection in elective biliary surgery: Controlled trial using one dose cephamandole. Aust NZ J Surg, 1985; 55(1):19–22; doi: 10.1111/j.1445-2197.1985.tb00848.x
9.
AbramovD, JeroukhimovI, YinnonAM, et al.Antibiotic prophylaxis in umbilical and incisional hernia repair: A prospective randomised study. Eur J Surg, 1996; 162(12):945–949.
10.
BratzlerDW, HouckPM. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis, 2004; 38(12):1706–1715; doi: 10.1016/j.amjsurg.2005.01.015
11.
ConteJE Jr, CohenSN, RoeBB, ElashoffRM. Antibiotic prophylaxis and cardiac surgery. A prospective double-blind comparison of single-dose versus multiple-dose regimens. Ann Intern Med 972;76(6):943–949; doi: 10.7326/0003-4819-76-6-943
12.
StrachanCJ, BlackJ, PowisSJ, et al.Prophylactic use of cephazolin against wound sepsis after cholecystectomy. Br Med J, 1977; 1(6071):1254–1256; doi: 10.1136/bmj.1.6071.1254
13.
MendelsonJ, PortnoyJ, De Saint VictorJR, et al.Effect of single and multidose cephradine prophylaxis on infectious morbidity of vaginal hysterectomy. Obstet Gynecol, 1979; 53(1):31–35.
14.
HigginsAF, LewisA, NooneP, HoleML. Single and multiple dose cotrimoxazole and metronidazole in colorectal surgery. Br J Surg, 1980; 67(2):90–92; doi: 10.1002/bjs.1800670206.
15.
HamodKA, SpenceMR, RosensheinNB, DillonMB. Single-dose and multidose prophylaxis in vaginal hysterectomy: A comparison of sodium cephalothin and metronidazole. Am J Obstet Gynecol, 1980; 136(8):976–979; doi: 10.1016/0002-9378(80)90620-1
16.
GierckskyKE, DanielsenS, GarbergO, et al.A single dose tinidazole and doxycycline prophylaxis in elective surgery of colon and rectum. A prospective controlled clinical multicenter study. Ann Surg, 1982; 195(2):227–231; doi: 10.1097/00000658-198202000-00019
17.
HemsellDL, HeardML, NoblesBJ, HemsellPG. Single-dose cefoxitin ,prophylaxis for premenopausal women undergoing vaginal hysterectomy. Obstet Gynecol, 1984; 63(3):285–290.
18.
GöranssonG, Nilsson-EhleI, OlssonSA, et al.Single versus multiple dose doxycycline prophylaxis in elective colorectal surgery. Acta Chir Scand, 1984; 150(3):245–249.
19.
GonikB. Single- versus three-dose cefotaxime prophylaxis for cesarean section. Obstet Gynecol, 1985; 65(2):189–193.
20.
DiPiroJ, CheungR, BowdenT Jr. Single dose systemic antibiotic prophylaxis of surgical wound infections. Am J Surg, 1986; 152:552–559; doi: 10.1016/0002-9610(86)90228-x
21.
JuulP, KlaaborgKE, KronborgO. Single or multiple doses of metronidazole and ampicillin in elective colorectal surgery. A randomized trial. Dis Colon Rectum, 1987; 30(7):526–528; doi: 10.1007/BF02554782
22.
BuckleR, HughesGN, SnodgrassT, HuchcroftSA. Perioperative cefazolin prophylaxis in hip fracture surgery. Can J Surg, 1990; 33(2):122–127.
23.
GarottaF, PamparanaF. Antimicrobial prophylaxis with ceftizoxime versus cefuroxime in orthopedic surgery. Ceftizoxime Orthopedic Surgery Italian Study Group. J Chemother, 1991; 3(Suppl 2):34–35.
24.
BeckerJM, AlexanderDP. Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management. Ann Surg, 1991; 213(3):242–247; doi: 10.1097/00000658-199103000-00011
25.
AbergC, ThoreM. Single versus triple dose antimicrobial prophylaxis in elective abdominal surgery and the impact on bacterial ecology. J Hosp Infect n, 1991; 18(2):149–154; doi: 10.1016/0195-6701(91)90160-a
26.
OlakJ, JeyasinghamK, Forrester-WoodC, et al.Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery. Ann Thorac Surg, 1991; 51(6):956–958; doi: 10.1016/0003-4975(91)91014-m
27.
TsangTM, TamPK, SaingH. Antibiotic prophylaxis in acute non-perforated appendicitis in children: Single dose of metronidazole and gentamicin. J R Coll Surg Edinb, 1992; 37(2):110–112.
28.
BatesT, RobertsJV, SmithK, GermanKA. A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery. Postgrad Med J, 1992; 68(804):811–816; doi: 10.1136/pgmj.68.804.811
29.
TuranoA. New clinical data on the prophylaxis of infections in abdominal, gynecologic, and urologic surgery. Multicenter Study Group. Am J Surg, 1992; 164(4A Suppl):16S–20S; doi: 10.1016/s0002-9610(06)80052-8
30.
WymengaA, van-HornJ, TheeuwesA, et al.Cefuroxime for prevention of postoperative coxitis. One versus three doses tested in a randomized multicenter study of 2,651 arthroplasties. Acta Orthop Scand, 1992; 63(1):19–24; doi: 10.3109/17453679209154842
31.
MeijerWS, SchmitzPI. Prophylactic use of cefuroxime in biliary tract surgery: randomized controlled trial of single versus multiple dose in high-risk patients. Galant Trial Study Group. Br J Surg, 1993; 80(7):917–921; doi: 10.1002/bjs.1800800742
32.
GalbraithU, SchillingJ, von SegesserLK, et al.Antibiotic prophylaxis in cardiovascular surgery: A prospective randomized comparative trial of one day cefazolin versus single dose cefuroxime. Drugs Exp Clin Res, 1993; 19(5):229–234.
33.
NooyenSM, OverbeekBP, Brutel de la RiviereA, et al.Prospective randomised comparison of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery bypass grafting. Eur J Clin Microbiol Infect Dis, 1994; 13(12):1033–1037; doi: 10.1007/BF02111823
34.
KowL, ToouliJ, BrookmanJ, McDonaldPJ. Comparison of cefotaxime plus metronidazole versus cefoxitin for prevention of wound infection after abdominal surgery. World J Surg, 1995; 19(5):680–686; doi: 10.1007/BF00295902
35.
ScherKS. Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg, 1997; 63(1):59–62.
36.
McDonaldM, GrabschE, MarshallC, ForbesA. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: A systematic review [see comments]. Austr NZ J Surg, 1998; 68(6):388–396; doi: 10.1111/j.1445-2197.1998.tb04785.x
37.
Carsenti-EtesseH, DoyonF, DesplacesN, et al.Epidemiology of bacterial infection during management of open leg fractures. Eur J Clin Microbiol Infect Dis, 1999; 18(5):315–323; doi: 10.1007/pl00015012
38.
ZelenitskySA, SilvermanRE, DuckworthH, HardingGK. A prospective, randomized, double-blind study of single high dose versus multiple standard dose gentamicin both in combination withmetronidazole for colorectal surgicalprophylaxis. J Hosp Infect, 2000; 46(2):135–140; doi: 10.1053/jhin.2000.0814
39.
LindeboomJA, BaasEM, KroonFH. Prophylactic single-dose administration of 600 mg clindamycin versus 4-time administration of 600 mg clindamycin in orthognathic surgery: A prospective randomized study in bilateral mandibular sagittal ramus osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003; 95(2):145–149; doi: 10.1067/moe.2003.54
40.
BratzlerDW, HouckPM, RichardsC, et al.Use of antimicrobial prophylaxis for major surgery: Baseline results from the national surgical infection prevention project. Arch Surg, 2005; 140(2):174–182; doi: 10.1001/archsurg.140.2.174
41.
FukatsuK, SaitoH, MatsudaT, et al.Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant Staphylococcus aureus and on the incidence of wound infection. Arch Surg, 1997; 132(12):1320–1325; doi: 10.1001/archsurg.1997.01430360066012
42.
HarbarthS, SamoreMH, LichtenbergD, CarmeliY. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation, 2000; 101(25):2916–2921; doi: 10.1161/01.cir.101.25.2916
43.
EspositoS, IannielloF, LeoneS, et al.Surveillance of post-operative infections and management of antibiotic surgical prophylaxis in an Italian region. J Chemother, 2004; 16(2):160–165; doi: 10.1179/joc.2004.16.2.160
44.
DellingerEP, HausmannSM, BratzlerDW, et al.Hospitals collaborate to decrease surgical site infections. Am J Surg, 2005; 190(1):9–15; doi: 10.1016/j.amjsurg.2004.12.001
45.
AndersonDJ, KayeKS, ClassenD, et al.Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol, 2008; 29(Suppl 1):S51–61; doi: 10.1086/676022
46.
BratzlerDW, DellingerEP, OlsenKM, et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect, 2013; 14(1):73–156; doi: 10.1089/sur.2013.9999
47.
AndersonDJ, PodgornyK, Berrios-TorresSI, et al.Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol, 2014; 35(6):605–627; doi: 10.1086/676022.
48.
Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther, 2016; 58(1495):63–68.
49.
KanayamaM, HashimotoT, ShigenobuK, et al.Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine, 2007; 6(4):327–329; doi: 10.3171/spi.2007.6.4.7
50.
MilianiK, L'HériteauF, AstagneauP. Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: Results of a multilevel analysis from the INCISO Surveillance Network. J Antimicrob Chemother, 2009; 64(6):1307–1315; doi: 10.1093/jac/dkp367
51.
OzgunH, ErtugrulBM, SoyderA, et al.Peri-operative antibiotic prophylaxis: Adherence to guidelines and effects of educational intervention. Int J Surgery, 2010; 8(2):159–163; doi: 10.1016/j.ijsu.2009.12.005
52.
HaynesK, LinkinDR, FishmanNO, et al.Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. J Am Med Inform Assoc, 2011; 18(2):164–168; doi: 10.1136/jamia.2009.002998.
53.
YoungB, NgTM, TengC, et al.Nonconcordance with surgical site infection prevention guidelines and rates of surgical site infections for general surgical, neurological, and orthopedic procedures. Antimicrob Agents Chemother, 2011; 55(10):4659–4663; doi: 10.1128/AAC.00562-11
54.
HohmannC, EickhoffC, Radziwill,R, SchulzM. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: A multicentre evaluation involving pharmacy interns. Infection, 2012; 40(2):131–137; doi: 10.1007/s15010-011-0204-7
55.
FriedmanND, StylesK, GrayAM, et al.Compliance with surgical antibiotic prophylaxis at an Australian teaching hospital. Am J Infect Control, 2013; 41(1):71–74; doi: 10.1016/j.ajic.2012.02.012
56.
BehnkeM, HansenS, LeistnerR, et al.Nosocomial infection and antibiotic use: A second national prevalence study in Germany. Dtsch Arztebl Int, 2013; 110(38):627–633; doi: 10.3238/arztebl.2013.0627
57.
KnoxMC, EdyeM. Adherence to surgical antibiotic prophylaxis guidelines in New South Wales, Australia: Identifying Deficiencies and regression analysis of contributing factors. Surg Infect, 2016; 17(2):203–209; doi: 10.1089/sur.2015.195
58.
MurriR, de BelvisAG, FantoniM, et al.Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis. Int J Qual Health Care, 2016; 28(4): 502–507; doi: 10.1093/intqhc/mzw055
59.
SakodaM, IinoS, MatakiY, et al.Influence of a shorter duration of post-operative antibiotic prophylaxis on infectious complications in patients undergoing elective liver resection. Surg Infect, 2017; 18(2):149–156; doi: 10.1089/sur.2016.170
60.
MohamedR, WallJ, ArumainathanR, et al.Assessing antibiotic stewardship using the surgical site infection prevention bundle. Br J Hosp Med (Lond), 2018; 79(11):643–647; doi: 10.12968/hmed.2018.79.11.643
61.
QuattrocchiA, BarchittaM, MaugeriA, et al.Appropriateness of perioperative antibiotic prophylaxis in two Italian hospitals: A pilot study. Ann Ig, 2018; 30(5 Suppl 2):36–44; doi: 10.7416/ai.2018.2249
62.
VersportenA, ZarbP, CaniauxI, et al.Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey. Lancet Glob Health, 2018; 6(6):e619–e629; doi: 10.1016/S2214-109X(18)30186-4
63.
IeranoC, ThurskyK, MarshallC, et al.Appropriateness of surgical antimicrobial prophylaxis practices in Australia. JAMA Netw Open, 2019; 2(11):e1915003–e1915003; doi: 10.1001/jamanetworkopen.2019.15003
64.
AllegranziB, ZayedB, BischoffP, et al.New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis, 2016; 16(12):e288–e303; doi: 10.1016/S1473-3099(16)30402-9
65.
Berrios-TorresSI, UmscheidCA, BratzlerDW, et al.Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg, 2017; 152(10):784–791; doi: 10.1001/jamasurg.2017.0904
66.
de JongeSW, BoldinghQJJ, SolomkinJS, et al.Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: A systematic review and meta-analysis. Lancet Infect Dise, 2020; 20(10):1182–1192; doi: 10.1016/S1473-3099(20)30084-0
67.
NusrathS, NairA, DasuS, et al.Single-dose prophylactic antibiotic versus extended usage for four days in clean-contaminated oncological surgeries: A randomized clinical trial. Indian J Surgical Oncol, 2020; 11(3):378–386; doi: 10.1007/s13193-020-01163-x
68.
GahmJ, Ljung KonstantinidouA, LagergrenJ, et al.Effectiveness of single vs multiple doses of prophylactic intravenous antibiotics in implant-based breast reconstruction: A randomized clinical trial. JAMA Netw Open, 2022; 5(9):e2231583–e2231583; doi: 10.1001/jamanetworkopen.2022.31583
69.
EzeikeAC, AgboghoromaCO, EfetieER, et al.Comparison of short course versus long course antibiotic prophylaxis for caesarean section: A randomised controlled trial. West Afr J Med, 2021; 38(4):398–404.
70.
BerryP, RosenbergerL, GuidryC, et al.Intraoperative versus extended antibiotic prophylaxis in liver transplant surgery: A randomized controlled pilot trial. Liver Transplant, 2019; 25:1043–1053; doi: 10.1002/lt.25486
71.
KlubaS, ReinertS, KrimmelM. Single-dose versus prolonged antibiotic prophylaxis for alveolar bone grafting in cleft patients. Int J Oral Maxillofac Surg, 2023; 52(5):564–568; doi: 10.1016/j.ijom.2022.10.002
72.
CurranJ, LoJ, LeungV, et al.Estimating daily antibiotic harms: An umbrella review with individual study meta-analysis. Clin Microbiol Infect, 2022; 28(4):479–490; doi: 10.1016/j.cmi.2021.10.022
73.
TeshomeBF, VouriSM, HamptonN, et al.Duration of exposure to antipseudomonal β-lactam antibiotics in the critically ill and development of new resistance. Pharmacotherapy, 2019; 39(3):261–270; doi: 10.1002/phar.2201
74.
ArcherGL, ArmstrongBC. Alteration of staphylococcal flora in cardiac surgery patients receiving antibiotic prophylaxis. J Infect Dis, 1983; 147(4):642–9; doi: 10.1093/infdis/147.4.642
75.
TerpstraS, NoordhoekGT, VoestenHG, et al.Rapid emergence of resistant coagulase-negative staphylococci on the skin after antibiotic prophylaxis. J Hosp Infect, 1999; 43(3):195–202; doi: 10.1053/jhin.1999.0636
76.
KachrooS, DaoT, ZabanehF, et al.Tolerance of vancomycin for surgical prophylaxis in patients undergoing cardiac surgery and incidence of vancomycin-resistant enterococcus colonization. Ann Pharmacother, 2006; 40(3):381–385; doi: 10.1345/aph.1G565
77.
PadillaE, OmsL, EspejoE, et al.Rifampin resistance in staphylococci after rifaximin intake for surgical prophylaxis in elective colorectal surgery. Antimicrob Agents Chemother, 2018; 62(12):e01353-18; doi: 10.1128/AAC.01353-18
78.
KellyMP, GilillandJM, BlackburnBE, et al.Extended oral antibiotics increase bacterial resistance in patients who fail 2-stage exchange for periprosthetic joint infection. J Arthroplasty, 2022; 37(8):S989–S996; doi: 10.1016/j.arth.2022.01.027
79.
SchechnerV, FallachN, BraunT, et al.Antibiotic exposure and the risk of hospital-acquired diarrhoea and Clostridioides difficile infection: A cohort study. J Antimicrob Chemother, 2021; 76(8):2182–2185; doi: 10.1093/jac/dkab151
DubberkeER, CarlingP, CarricoR, et al.Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol, 2014; 35(6):628–645; doi: 10.1086/676023
82.
KirkwoodKA, GulackBC, IribarneA, et al.A multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis. J Thorac Cardiovasc Surg, 2018; 155(2):670–678; doi: 10.1016/j.jtcvs.2017.09.089
83.
PoeranJ, MazumdarM, RasulR, et al.Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2016; 151(2):589–597; doi: 10.1016/j.jtcvs.2015.09.090
84.
PorterMW, BurdiWJr, CasavantJD, et al.Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery. Infect Control Hosp Epidemiol, 2022; 43(12):1873–1879; doi: 10.1017/ice.2021.529
85.
CalvertJK, HoltSK, MossanenM, et al.Use and outcomes of extended antibiotic prophylaxis in urological cancer surgery. J Urol, 2014; 192(2):425–429; doi: 10.1016/j.juro.2014.02.096
86.
Branch-EllimanW, O'BrienW, StrymishJ, et al.Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg, 2019; 154:590–598; doi: 10.1001/jamasurg.2019.0569
87.
CarignanA, AllardC, PepinJ, et al.Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis, 2008; 46(12):1838–1843; doi: 10.1086/588291
88.
DellitTH, ChanJD, FultonC, et al.Reduction in Clostridium difficile infections among neurosurgical patients associated with discontinuation of antimicrobial prophylaxis for the duration of external ventricular drain placement. Infect Control Hosp Epidemiol, 2014; 35(5):589–590; doi: 10.1086/675828
89.
BernatzJT, SafdarN, HetzelS, AndersonPA. Antibiotic overuse is a major risk factor for Clostridium difficile Infection in surgical patients. Infect Control Hosp Epidemiol, 2017; 38(10):1254–1257; doi: 10.1017/ice.2017.158
90.
MuiLM, NgCS, WongSK, et al.Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. ANZ J Surg, 2005; 75(6):425–428; doi: 10.1111/j.1445-2197.2005.03397.x
