Source: Kanji S. Antimicrobial prophylaxis in surgery. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146073703. Accessed March 29, 2017.
Prophylactic administration of antibiotics to prevent development of surgical-site infection (SSI).
SSIs by definition occur by postoperative day 30 except for those associated with prosthesis implantation, in which period extends to 1 year.
Incisional (eg, cellulitis of incision site)
Involving organ or space (eg, with meningitis)
RISK FACTORS FOR SURGICAL-SITE INFECTION
Traditional classification system developed by National Research Council (NRC) stratifying surgical procedures by infection risk in Table 1.
NRC classification system does not account for influence of:
Study on the Efficacy of Nosocomial Infection Control (SENIC) analyzed more than 100,000 surgery cases.
Identified risk factors associated with increased incidence of SSI:
Operations lasting >2 hours.
Contaminated or dirty procedures.
>3 underlying medical diagnoses.
Stratification of NRC classification described in Table 1 by number of SENIC risk factors present resulted in variation of infection rates by as much as factor of 15 within same operative category.
SENIC risk assessment technique has been modified to include American Society of Anesthesiologists preoperative assessment score.
TABLE 1.National Research Council Wound Classification, Risk of Surgical-Site Infection (SSI), and Indication for Antibiotics ||Download (.pdf) TABLE 1. National Research Council Wound Classification, Risk of Surgical-Site Infection (SSI), and Indication for Antibiotics
| ||SSI Rate (%) || || |
|Classification ||Preoperative Antibiotics ||No Preoperative Antibiotics ||Criteria ||Antibiotics |
|Clean ||5.1 ||0.8 ||No acute inflammation or transection of GI, oropharyngeal, genitourinary, biliary, or respiratory tracts. Elective case, no technique break. ||Not indicated unless high-risk procedurea |
|Clean–contaminated ||10.1 ||1.3 ||Controlled opening of aforementioned tracts with minimal spillage/minor technique break. Clean procedures performed emergently or with major technique breaks. ||Prophylactic antibiotics indicated |
|Contaminated ||21.9 ||10.2 ||Acute, nonpurulent inflammation present. Major spillage/technique break during clean–contaminated procedure. ||Prophylactic antibiotics indicated |
|Dirty ||N/A ||N/A ||Obvious preexisting infection present (abscess, pus, or necrotic tissue present). ||Therapeutic antibiotics required |