New guidance: Antibiotics should be halted upon closure of incisions

Medical Xpress / Soc for Healthcare Epidemiology of Am / Infection Control and Hospital Epidemiology ^ | May 4, 2023 | Michael S. Calderwood, MD, MPH et al

[ConservativeMind]

Antibiotics administered before and during surgery should be discontinued immediately after a patient's incision is closed, according to updated recommendations for preventing surgical site infections. Experts found no evidence that continuing antibiotics after a patient's incision has been closed, even if it has drains, prevents surgical site infections. Continuing antibiotics does increase the patient's risk of C. difficile infection, which causes severe diarrhea, and antimicrobial resistance.

"Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update," provides evidence-based strategies for preventing infections for all types of surgeries from top experts from five medical organizations led by the Society for health care Epidemiology of America.

"Many surgical site infections are preventable," said Michael S. Calderwood, MD, MPH. "Ensuring that health care personnel know, utilize, and educate others on evidence-based prevention practices is essential to keeping patients safe during and after their surgeries."

Surgical site infections are among the most common and costly health care-associated infections, occurring in approximately 1% to 3% of patients undergoing inpatient surgery. Patients with surgical site infections are up to 11 times more likely to die compared to patients without such infections.

[ConservativeMind]

C. difficile risk increases with added antibiotics after surgical site closing.

There are other best practices for other circumstances, in the article.

[ConservativeMind]

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[Skywise]

I agree if the wound is closed that you probably don’t need antibiotics… but with an active drain?! That flies in the face of credulity

A drain is STILL an open incision!

[DannyTN]

I still think the problem is not over use of antibiotics. It’s under use. They don’t do cultures to make sure the infection is really gone.

So they send people out into the world who are speaders. And by not killing off the problem bacteria, they are selecting for antibiotic resistance.

[armydoc]

Most open incisions (wounds) don’t need antibiotics, unless there is an active clinical infection present.