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11-12-2011 | Article

Excessive administration of antibiotics unnecessary prior to plastic surgery


Free abstract

MedWire News: Study results suggest that administration of antibiotics as a prophylaxis against surgical site infections (SSIs) is not necessary for the majority of plastic surgery procedures.

"Although guidelines for antibiotic prophylaxis to prevent SSIs exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics," explain researchers.

"Due to the absence of specific guidelines, plastic surgeons are generally reluctant to approve a new prophylactic regimen for fear of a higher risk of infection, and administration of antibiotics is often left to personal preference of the surgeon," they add.

To assess if limiting antibiotic prophylaxis to high-risk plastic surgery procedures does increase the infection rate, Francesca Toia (Università degli Studi di Palermo, Italy) and colleagues enrolled 978 consecutive patients undergoing elective reconstructive or cosmetic surgical procedures between April 2009 and April 2010.

The team classified the operations into four groups based on how "clean" they were likely to be with group one operations (superficial skin surgery and mucosal excisions) having the lowest risk for infection and groups three (microsurgery, prosthetic surgery, incisional hernia, and clean nonprosthetic osteoarticular surgery) and four (clean-contaminated procedures involving oral cavity or genitourinary system) the highest.

In total, 229 (23.4%) patients were given antibiotic prophylaxis prior to their operations. No patients in group one received antibiotics, whereas all patients in groups three and four received the prophylaxis. In group two (clean procedures such as those involving the head and neck and breasts, among other organs, and rhinoplasty), only patients thought to be at increased risk were given antibiotics, such as those with an American Society of Anesthesiology score of 3 or more, or those undergoing an operation of 3 hours or more.

Overall, 1.4% of the operations resulted in a SSI, with a rate of 1.1% for clean surgery and 3.8% for clean-contaminated surgery. For individual surgery types, the highest rate was for oral oncologic surgery, at 5.3%.

"The application of the SSI prophylaxis protocol for plastic surgery described above allows keeping SSI risk very low (overall 1.4%), to prevent the increase in MDR [multi-drug resistances], in opportunistic infections and in allergic reactions associated with indiscriminate use of antibiotics and, last but not least, to lower costs," conclude the authors in the Journal of Plastic and Reconstructive Surgery.

By Helen Albert