Prophylactic antibiotics in surgery

Surgical-site infection (SSI) is a major cause of morbidity in hospitalised patients. In surgery antibiotic prophylaxis is used, in conjunction with other preventative measures, to reduce the risk of SSI. The main goal of surgical prophylaxis is to use antimicrobials in an evidence-based manner, while minimising the risk of adverse events and the effect of antibiotics on the patient's own flora. A range of factors need to be taken into account in choosing an appropriate prophylactic agent, such as the antimicrobial spectrum, likely contaminating organisms, patient risk factors and allergies and local antibiotic resistance patterns. Local policies should be available to guide antibiotic choice, but advice should be sought for complex patients. Healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and resistant Gram negatives should also be taken into account and antibiotic choice tailored accordingly. The use of antibiotic prophylaxis is no substitute for adherence to appropriate measures for control of infection or for good surgical technique.