Žilvinas DambrauskasŽilvinas Dambrauskas, MD, PhD, MD, PhDDepartment of SurgeryDepartment of Surgery

Lithuanian University of Health SciencesLithuanian University of Health Sciences20120122--1010--0101

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1. Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis. 2001;7:220–224.2. American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 1999;56:1839–1888.3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control. 1999;27:97–134.388.

www.nice.org.uk/CG74

McDonald M et al. McDonald M et al. Aust NZ J SurgAust NZ J Surg. 1998;68:388–396. Adapted with permission from Blackwell Synergy © 1998.. 1998;68:388–396. Adapted with permission from Blackwell Synergy © 1998.

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www.nice.org.uk/CG74

Infe

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Hours From IncisionHours From Incision

14/36914/369

5/6995/699

5/1,0095/1,009

2/1802/180

1/611/61

1/411/411/471/47

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≤–≤–33 >–2>–2 >–1>–1 00 11 22 33 44 ≥≥55

Classen DC et al. Classen DC et al. N Engl J MedN Engl J Med. 1992;326:281–286. Copyright © 1992 Massachusetts Medical Society. All rights reserved.. 1992;326:281–286. Copyright © 1992 Massachusetts Medical Society. All rights reserved.

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Single effective I/V dose (I A) 20-60 min before incision (induction of

anaesthesia) Second dose could be used if :

surgery > 3-4 hr blood loss > 1500 ml

Further use of AB after 24 hr from prophylaxis is justified only in patients with high risk of septic complications (treatment only!)

Calise F et al. Perioperative antibiotic prophylaxis in adults. Outline of the principal recommendations. National reference guidelines. Minerva Anestesiol. 2009 Sep;75(9):543-7, 548-52. English, Italian. PubMed PMID: 19644438.

www.nice.org.uk/CG74

Type of SurgeryType of Surgery Recommended ABRecommended AB AlternativeAlternative

Esophagectomy, Esophagectomy, gastrectromygastrectromy

Cefazolin 2 gCefazolin 2 g Cefuroxime 1,5 gCefuroxime 1,5 g

Stomach and/or Stomach and/or small intestinesmall intestine

Cefazolin 2 gCefazolin 2 gMetronidazole 0.5 - 1 gMetronidazole 0.5 - 1 g

Cefuroxime 1,5 gCefuroxime 1,5 g

HPB surgeryHPB surgery Cefazolin 2 gCefazolin 2 gMetronidazole 0.5 - 1 gMetronidazole 0.5 - 1 g

Clindamycin 600 mgClindamycin 600 mg

AppendectomyAppendectomy Cefazolin 2 gCefazolin 2 gMetronidazole 0.5 - 1 gMetronidazole 0.5 - 1 g

Gentamycin 240 mg, Gentamycin 240 mg, Metronidazole 0.5 gMetronidazole 0.5 g

ColorectalColorectal Cefazolin 2 gCefazolin 2 gMetronidazole 0.5 - 1 gMetronidazole 0.5 - 1 g

Gentamycin 240 mg, Gentamycin 240 mg, Metronidazole 0.5 gMetronidazole 0.5 g

Penetrating Penetrating traumatrauma

Penicilin 5 m, Penicilin 5 m, Gentamycin 240 mg, Gentamycin 240 mg, Metronidazole 0.5 gMetronidazole 0.5 g

Cefuroxime 1,5 gCefuroxime 1,5 gMetronidazole 0.5 - 1 Metronidazole 0.5 - 1

gg

Hernia repairHernia repair Cefazolin 2 gCefazolin 2 g Clindamycin 600 mgClindamycin 600 mg

Breast surgeryBreast surgery Cefazolin 2 gCefazolin 2 g Clindamycin 600 mgClindamycin 600 mg

Indicator No. 1 % of patients, who received AB within 1 hr prior to incision

Indicator No. 2 % of patients, who received AB based on the Guidelines

Indicator No. 3 % of patients, who received no AB after 24 hr