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The timing of surgical antimicrobial prophylaxis

Weber, W. P. and Marti, W. R. and Zwahlen, M. and Misteli, H. and Rosenthal, R. and Reck, S. and Fueglistaler, P. and Bolli, M. and Trampuz, A. and Oertli, D. and Widmer, A. F.. (2008) The timing of surgical antimicrobial prophylaxis. Annals of surgery, Vol. 247. pp. 918-926.

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Official URL: http://edoc.unibas.ch/dok/A6006054

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Abstract

OBJECTIVE: To obtain precise information on the optimal time window for surgical antimicrobial prophylaxis. SUMMARY BACKGROUND DATA: Although perioperative antimicrobial prophylaxis is a well-established strategy for reducing the risk of surgical site infections (SSI), the optimal timing for this procedure has yet to be precisely determined. Under today's recommendations, antibiotics may be administered within the final 2 hours before skin incision, ideally as close to incision time as possible. METHODS: In this prospective observational cohort study at Basel University Hospital we analyzed the incidence of SSI by the timing of antimicrobial prophylaxis in a consecutive series of 3836 surgical procedures. Surgical wounds and resulting infections were assessed to Centers for Disease Control and Prevention standards. Antimicrobial prophylaxis consisted in single-shot administration of 1.5 g of cefuroxime (plus 500 mg of metronidazole in colorectal surgery). RESULTS: The overall SSI rate was 4.7% (180 of 3836). In 49% of all procedures antimicrobial prophylaxis was administered within the final half hour. Multivariable logistic regression analyses showed a significant increase in the odds of SSI when antimicrobial prophylaxis was administered less than 30 minutes (crude odds ratio = 2.01; adjusted odds ratio = 1.95; 95% confidence interval, 1.4-2.8; P > 0.001) and 120 to 60 minutes (crude odds ratio = 1.75; adjusted odds ratio = 1.74; 95% confidence interval, 1.0-2.9; P = 0.035) as compared with the reference interval of 59 to 30 minutes before incision. CONCLUSIONS: When cefuroxime is used as a prophylactic antibiotic, administration 59 to 30 minutes before incision is more effective than administration during the last half hour.
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik)
03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Innere Organe
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Innere Organe
03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Ehemalige Einheiten Operative Fächer (Klinik) > Allgemein- und Viszeralchirurgie (Oertli)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Ehemalige Einheiten Operative Fächer (Klinik) > Allgemein- und Viszeralchirurgie (Oertli)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
UniBasel Contributors:Widmer, Andreas F.-X. and Oertli, Daniel and Marti, Walter R. and Trampuz, Andrej and Bolli, Martin and Weber, Walter P.
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Lippincott Williams & Wilkins
ISSN:0003-4932
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:07 Dec 2012 13:03
Deposited On:07 Dec 2012 12:59

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