The Role of Prophylactic Antibiotics in Preventing Wound Infection

Excerpt

In this country, antibiotics are probably more misused than used and except for a few “enlightened” souls, most of us continue to prescribe antibiotics today as was done in many developed countries several decades ago. We seem to be stuck in a time warp as far as the rational use of antibiotics in surgery is concerned. The most charitable reason for continuing to prescribe antibiotics haphazardly post-operatively for several days is that the “apprentice” model of learning has been followed faithfully with no thought or idea that such practice may be unnecessary and may indeed cause more harm than good. For most procedures in obstetrics and gynecology, in the absence of purulent abscesses and where wounds are classified as “clean contaminated”—the surgical wound infection (SWI) risk being two to five percent—the need for administration of “prophylactic” antibiotics is advocated unlike “dirty” wounds where “curative” antibiotics are administered for a prolonged period of time post-operatively as well. S. aureus is the most common pathogen causing surgical site infection (SSI), accounting for 30 % of SSIs in the United States. Colonization with S. aureus, primarily in the nares, occurs in roughly one in four persons and increases the risk of SSI by 2- to 14-fold. 1. …