[Evidence-based antibiotic prophylaxis in general and visceral surgery]

Perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections

Background

The increase of antimicrobial resistances to first- and second-line antibiotics, especially of Gram-negative bacteria, and the lack of novel antimicrobial substances are a challenge in the treatment of intra-abdominal infections.

Methods

Review article.

Results

The efficacy and safety of perioperative antibiotic prophylaxis in visceral surgery has been demonstrated by several meta-analyses. Perioperative antibiotic prophylaxis is defined as a single administration of antibiotics shortly before a surgical intervention. A so-called prolonged prophylaxis including the postoperative period (e.g. 1-3 days postoperatively) should be avoided as it does not reduce the number of wound infections and is associated with an increased risk of antimicrobial resistance and side effects. Antimicrobial management of severe intra-abdominal infections involves a delicate balance of optimizing empirical therapy which has been shown to improve outcomes while simultaneously reducing unnecessary use of antimicrobials.

Conclusion

Antimicrobial resistance poses a serious threat to human health and requires a rational use of antibiotics to curb further spreading. This applies for perioperative prophylaxis as well as for the treatment of intra-abdominal infections.

[Surgical standards in perioperative treatment]

Perioperative medicine includes the areas of clarification, patient safety, hygiene standards, prophylaxis for thrombosis and antibiotics, pain therapy and morbidity and mortality conference. All these procedures show how complex perioperative medicine is.

[Antibiotic prophylaxis and endoluminal tubes]

Surgical site infections are one of the most common complications after surgical procedures. The use of perioperative antibiotic prophylaxis can successfully reduce the number of wound infections. The indications, timing and choice of antibiotics are discussed critically. Taken together antibiotic prophylaxis should be evaluated depending on wound contamination, the type of operation and patient-specific risk factors. In the second part of this work the current literature on the effectiveness of endoluminal tubes in abdominal surgery is analyzed. While many surgeons use these tubes regularly in elective abdominal surgery, only few data are available on this topic. The use of nasogastric tubes in elective surgery should be avoided.