Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery. Antibiotic Prophylaxis in Hernia Repair and Breast Surgery: A Prospective Randomized Study Comparing Piperacillin/Tazobactam Versus Placebo Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis
BACKGROUND Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime . OBJECTIVE To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis . PATIENTS AND METHODS In this prospect i ve , double-blind clinical trial , 189 patients with carcinoma of the upper aerodigestive tract were r and omized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses . RESULTS An overall wound infection rate of 22 % was observed . The infection rate in patients receiving cefazolin was 24 % ( 22/92 ) vs. 21 % ( 20/97 ) in those receiving amoxicillin-clavulanate ; the difference was not statistically significant . Postoperative overall non-wound infection developed in 12 % ( 22/189 ) patients ; the rate of infection was 9.8 % ( 9/92 ) in patients receiving cefazolin vs. 13.4 % ( 13/97 ) in those receiving amoxicillin-clavulanate , without a statistically significant difference between the two groups . Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species . The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage . CONCLUSION In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin . However , when taking into account the fact that beta-lactamase containing strains have recently been spreading , amoxicillin-clavulanate should be the logical first choice Abstract Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery , its use for these clean procedures is widely adopted , albeit to a different extent in different countries , often on the personal decision of the individual surgeon . The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery . A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospect i ve r and omized clinical study . Patients were r and omly assigned to receive preoperative antibiotic prophylaxis or placebo . One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v . 30 minutes prior to the surgical procedure . Using statistical univariate analysis , the following variables were correlated with a higher infection risk :  age > 40 years , concomitant disease , WBC < 3500 , surgical wound size > 9 cm , use of drainages , non-prophylaxis . Using multivariate analysis , no antibiotic pre-operative prophylaxis , concurrent chronic diseases , especially diabetes ( risk 15 times higher ) , and length of intervention > 45 min ( risk 6 times higher ) were independent predictors of infection . Finally , patients with postoperative infections  had a significantly longer hospitalisation . One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair Objective To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for  surgical-site infections and remote infections such as respiratory tract infections ( RTIs ) and urinary tract infections ( UTIs ) . Methods The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local ( surgical wound ) and remote ( RTIs and UTIs ) infections  in a meta- analysis of r and omised controlled trials published between 1984 and 2003 . The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies . Results Evaluations were performed on 48 studies , for a total of 17 565 patients . Overall , 406 patients ( 4.8 % ) in the ceftriaxone group and 525 ( 6.3 % ) in the comparator group developed a surgical-site infection ( log odds ratio [ OR ] −0.30 [ CI −0.50 to −0.13 ] ; p < 0.0001 ) . RTIs were observed in 292 ( 6.01 % ) patients in the ceftriaxone group and in 369 ( 7.6 % ) patients in the comparator group , ( log OR −0.30 [ CI −0.55 to −0.09 ] ; p = 0.0013 ) . UTIs were reported for 2.2 % of the ceftriaxone prophylaxis patients compared with 3.74 % of the comparator group patients ( log OR −0.54 [ CI −1.18 to −0.16 ] ; p < 0.0001 ) . Overall , in clean surgery 195 ( 5.1 % ) and 234 ( 6.2 % ) patients developed a surgical site infection in the ceftriaxone and comparator groups , respectively ( log OR −0.22 [ CI −0.51 to 0.01 ] ; p = 0.0476 ) . RTIs were prevented for all but 1.57 % of patients in the ceftriaxone group and 2.62 % of patients in the comparator group ( p = 0.01 ) in clean surgery , and for 9.54 % of the ceftriaxone group versus 11.6 % of the comparator group ( p = 0.01 ) in clean-contaminated surgery . While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence ( log OR −0.21 [ CI 0.0–0.65 ] ; p = 0.7702 ) , this was clearly shown in the clean-contaminated surgery . In fact , 4.47 % of patients in the ceftriaxone group versus 7.52 % of patients in the comparator group developed a UTI ( log OR −0.56 [ CI −1.25 to −0.16 ] ; p < 0.0001 ) . Adverse events were observed in a similar proportion in the ceftriaxone prophylaxis and the comparator groups ( 0.35 % and 0.23 % , respectively ) . Duration of prophylaxis did not influence outcome of infection . Conclusions The meta- analysis showed that ceftriaxone is statistically superior to other antibiotics in preventing both local and remote postoperative infections
However , there was no real evidence supporting the second hypothesis that the relative risk of wound infection would substantially vary over different levels of surgery cleanliness .
: As well as antibiotic prophylaxis being a generally effective intervention for preventing postoperative wound infection , the level of this effectiveness would appear to be reasonably independent of what type of surgery is being considered .
In particular , perhaps a sensible philosophy would be to assume that antibiotic prophylaxis is effective in reducing the risk of wound infection for all types of surgery , even ones where no clinical trial data exists and make exceptions to this rule if , for certain types of surgery , it can be proved to the contrary
CONTEXT While the main focus of a meta- analysis is often to assess the effectiveness of a particular intervention in managing or curing a specific condition , there exists a substantial amount of information within published systematic review s that could be used to assess the validity of a generic hypothesis about the effectiveness of an intervention across a range of different but related conditions .
OBJECTIVE To systematic ally search for and then collate the results of meta-analyses for the effectiveness of antibiotic prophylaxis in preventing postoperative wound infection across various types of surgery in order to assess generic hypotheses about the effectiveness of this intervention in surgery as a whole .
With the relative risk of wound infection used as the measure of clinical effectiveness , the hypotheses to be assessed were first that antibiotic prophylaxis would be an effective intervention for preventing wound infection over a broad range of different surgical procedures , and second that there would be a substantial difference in the effectiveness of antibiotic prophylaxis between " clean " and " contaminated " surgical procedures .