INTRODUCTION: Antibiotic Prophylaxis for Surgical Infections Adolfo Turano, MD, Brescia, Italy

9 What is the optimum dose, timing, and duration of antibiotic prophylaxis? 9 What is the most cost-effective antibiotic prophyproblems, make it essential to pay particular attention to lactic regimen? the prevention of infections. These issues are addressed in this symposium with As advanced surgical skills and intricate life-saving new clinical data from large multicentered studies conprocedures push back the boundaries of survival, sur- ducted in over 7,000 patients. In these studies, patients geons are increasingly required to operate on critically undergoing a wide range of surgical procedures received ill patients. However, in spite of modern standards of third-generation cephalosporins. preoperative preparation and refinements in anesthetic Professor Turano reports that a single 1-g dose of and operative techniques, postoperative wound infec- cefotaxime was as effective as 3 doses in obtaining tions remain a serious problem. Indeed, after urinary effective prophylaxis coverage in 3,670 patients who had tract infection, surgical wound infections are the most undergone different surgical interventions. Dr. Duclos common nosocomial infection. describes his studies of antibiotic prophylaxis in transureIn addition to patient discomfort and morbidity thral resection of the prostate using single-dose cefoassociated with established wound sepsis, there are taxime at the catheter-removal period. Postoperative consequences involving nursing time and increased costs infection as the predominant complication following that are more easily quantified. It is estimated that an gynecologic surgery is the theme of Dr. Campillo's extra 6-14 days in-hospital are required for individual presentation. This study shows the efficacy and tolerabilpatients due to surgical wound infections. Clearly, post- ity of single-dose cefotaxime prophylaxis compared with operative wound infections put an additional strain on multiple doses of cefoxitin and cefazolin in reducing already over-stretched hospital resources. Thus, any associated morbidity. Professor Privitera reports on the procedure or drug regimen that can further reduce the successful treatment of the 92% of postoperative infecincidence of surgical infections is welcome. tions with cefotaxime. Surgical prophylaxis can be defined as the administraProfessor Jones presents the results of a literature tion of an antibiotic prior to a surgical procedure to review indicating that shorter-course regimens, includprevent postoperative infection. Delivery of parenteral ing single-dose administration of a third-generation antibiotics during the critical preoperative interval has cephalosporin (cefotaxime), are effective as surgical been demonstrated to reduce wound infection rates prophylaxis and are associated with a reduction in the markedly for a wide range of surgical procedures. incidence of adverse effects and associated costs. ProfesHowever, despite the consensus on antibiotic effectivesor Paradisi and Dr. Cheadle discuss the importance of ness, a number of questions are still open to discussion. choosing the most suitable prophylactic and postsurgical These include: regimen. Professor Canawati presents his findings on the 9 Which prophylactic regimen is most effective for antibacterial activity of the first third-generation cephawhich surgical procedure? losporin, cefotaxime, and the importance of its active 9 Which antibiotic has the most complete spectrum metabolite. of bacterial activity against the most commonly encounFinally, Dr. Davey states that cost-effectiveness analtered hospital pathogens? ysis has become a timely and necessary technique for the surgeon and the hospital administrator to use in allocatFrom the Istituto di Microbiologia, Universit~t degli Studi di ing shrinking resources. Brescia, Spedali Civili, Piazza Spedali Civili, Brescia, Italy. These reports shed new light on current issues using Requests for reprints should be addressed to Adolfo Turano, third-generation cephalosporins in surgical antibacterial MD, Istituto di Microbiologia, Universith degli Studi di Brescia, Spedali Civili, Piazza Spedali Civili, 1, 25100 Brescia, Italy. prophylaxis.

dvances in surgery and sophisticated life-saving procedures, together with the demand for care of A an increasing number of patients affected by multi-organ

THE AMERICAN JOURNAL OF SURGERY VOLUME 164 NO. 4A (SUPPL) OCTOBER 1992

IS