Once a patient’s incision is closed, antibiotics administered before and during surgery should be discontinued immediately, according to updated recommendations for preventing surgical-site infections.

That guidance, published in Infection Control and Healthcare Epidemiology, is based on the lack of evidence that surgical-site infections are prevented by continuing antibiotics after a patient’s incision has been closed, even if it has drains.

The Dartmouth Hitchcock Medical Center–led study cautioned that continuing antibiotics increases the patients’ risks of Clostridioides difficile infection, which causes severe diarrhea and antimicrobial resistance.

The recommendations are from five medical organizations led by the Society for Healthcare Epidemiology of America.

“Many surgical site-infections are preventable,” said lead author Michael S. Calderwood, MD, MPH, chief quality officer at Dartmouth Hitchcock Medical Center. “Ensuring that healthcare personnel know, utilize, and educate others on evidence-based prevention practices is essential to keeping patients safe during and after their surgeries.”

Other recommendations to help avoid surgical site infections include:

• Obtaining a full allergy history from patients who self-report penicillin allergy. The authors pointed out that many patients with a self-reported penicillin allergy can safely receive cefazolin, which is similar to penicillin, rather than alternate antibiotics that are less effective against surgical infections
• For high-risk procedures, especially orthopedic and cardiothoracic surgeries, decolonizing patients with an antistaphylococcal agent in the preoperative setting. Decolonization, which was elevated to an essential practice in this guidance, can reduce postoperative Staphylococcus aureus infections
• For patients with an elevated blood glucose level, monitoring and maintaining postoperative blood glucose levels between 110 and 150 mg/dL regardless of diabetes status. While higher glucose levels in the postoperative setting are associated with higher infection rates, the guidance warns that more intensive postoperative blood glucose control targeting levels below 110 mg/dL have been linked with a risk of significantly lowering the blood glucose levels and increasing the risk of stroke or death
• Using antimicrobial prophylaxis before elective colorectal surgery. The document notes that mechanical bowel preparation without the use of oral antimicrobial agents has been associated with significantly higher rates of surgical-site infection and anastomotic leakage. In fact, it emphasized that the use of parenteral, and oral antibiotics prior to elective colorectal surgery is now considered an essential practice
• Using negative-pressure dressings, especially for abdominal surgery or joint arthroplasty patients. Placing negative-pressure dressings, which appear to reduce fluid accumulation, over closed incisions was identified as a new option because evidence indicated those dressings reduce surgical-site infections in certain patients.

The document updates the 2014 Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. The Compendium, first published in 2008, is a collaborative effort led by the Society for Healthcare Epidemiology of America with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.

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