Principles of antibiotic use in surgery
Subject Areas : Veterinary Soft and Hard Tissue Surgery
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Keywords: Prophylactic antibiotic, Therapeutic antibiotic, Surgery, Antibiotic resistance,
Abstract :
Background: A review of the principles of antibiotic use in surgery
Objectives: Explain the principles of antibiotic use in surgery
Methods: A literature review using various publications related to the use of antibiotics in surgery
Results: Antibiotics are drugs used to treat bacterial infections. These drugs are divided into different groups based on their origin, spectrum of effect, clinical application and mechanism of action. Antibiotics are used in surgery for prevention of surgical site infections or treatment of established infections. Classification of surgeries into clean, clean-contaminated, contaminated and dirty procedures is considered the most important factor in choosing the type of antibiotic use. Antibiotics are not required for clean surgeries except in certain circumstances. Prophylactic antibiotics are used in clean-contaminated and contaminated surgeries to prevent postoperative infection. In dirty surgeries with an established infection, these drugs are used therapeutically. Prophylactic antibiotics are administered intravenously before the start of surgery to create a therapeutic concentration in the target tissues and prevent their infection. Therefore, drugs that can be injected intravenously are used for prophylaxis. Also, antibiotics are selected based on the natural flora of target tissues or operative site. Prophylactic drug administration is stopped at the end of the operation or continues up to 24 hours after the operation. Therapeutic use of antibiotics is started before surgery and continues during and after the operation until complete treatment of infection. Antibiotics are selected based on microbial culture and determination of antibiotic sensitivity. Presently, the use of novel methods has allowed topical application of antibiotics in surgery. This review article describes general characteristics of antibiotics and explains principles of their prophylactic and therapeutic use in surgery.
Conclusions: Antibiotics should be used judiciously to prevent antibiotic resistance while increasing their effectiveness in prevention and treatment of infections.
1. Saikia S, Chetia P. Antibiotics: from mechanism of action to resistance and beyond. Indian Journal of Microbiology. 2024; 29: 1-25. doi: https://doi.org/10.1007/s12088-024-01285-8
2. Halawa EM, Fadel M, Al-Rabia MW, Behairy A, Nouh NA, Abdo M, Olga R, Fericean L, Atwa AM, El-Nablaway M, Abdeen A. Antibiotic action and resistance: updated review of mechanisms, spread, influencing factors, and alternative approaches for combating resistance. Frontiers in Pharmacology. 2024; 14: 1305294. doi: 10.3389/fphar.2023.1305294
3. Anonymous. The history of antibiotics. Available online at: https://microbiologysociety.org/why-microbiology-matters/knocking-out-antimicrobial-resistance/amr-explained/the-history-of-antibiotics.html?_gl=1*twbzms*_up*MQ..*_ga*MTk1MDI2NDc3NS4xNzI2ODI4MjMw*_ga_KJR7LS80P1*MTcyNjgyODIyOS4xLjAuMTcyNjgyODIyOS4wLjAuMA.
4. Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, present and future. Current Opinion in Microbiology. 2019; 51: 72-80. doi: https://doi.org/10.1016/j.mib.2019.10.008
5. Gould K. Antibiotics: from prehistory to the present day. Journal of Antimicrobial Chemotherapy. 2016; 71 (3): 572-575. doi:10.1093/jac/dkv484
6. Varley AJ, Sule J, Absalom AR. Principles of antibiotic therapy. Continuing Education in Anaesthesia, Critical Care & Pain. 2009, 9 (6): 184-188. doi:10.1093/bjaceaccp/mkp035
7. Caneschi A, Bardhi A, Barbarossa A, Zaghini A. The use of antibiotics and antimicrobial resistance in veterinary medicine, a complex phenomenon: a narrative review. Antibiotics. 2023, 12 (3): 487. doi: https://doi.org/10.3390/antibiotics12030487
8. Anonymous. Few antibiotics under development. Available online at: https://www.reactgroup.org/toolbox/understand/how-did-we-end-up-here/few-antibiotics-under-development/.
9. Lyssens A. Systemic antimicrobial use in the prevention of surgical site infections: sense or non-sense. 2018. Doctoral dissertation, Ghent University.
10. Anonymous. Mechanisms of antibacterial drugs. Available online at: https://open.oregonstate.education/microbiology/chapter/14-2mechanisms-of-antibacterial-drugs/.
11. Etebu E, Arikekpar I. Antibiotics: classification and mechanisms of action with emphasis on molecular perspectives. International Journal of Applied Microbiology and Biotechnology Research. 2016; 4 (2016): 90-101.
12. Swanson EA. Updates in the use of antibiotics, biofilms. Veterinary Clinics: Small Animal Practice. 2022; 52 (2):e1-e19. doi: https://doi.org/10.1016/j.cvsm.2022.01.001
13. Nakamura RK, Tompkins E. Nosocomial infections. Compendium. 2012; 34 (4):E1-E10.
14. Williams J. The why and how of antimicrobial prophylaxis. BSAVA Companion.2018; 11: 4-7. doi: https://doi.org/10.22233/20412495.1118.4
15. Devriendt N, Mortier F, de Rooster H. Antimicrobial prophylaxis in canine and feline surgery. Vlaams Diergeneeskundig Tijdschrift. 2023; 92 (3): 131-141.
16. Findji L. Antibiotics in surgical patients. Clinician’s Brief. 2014; 19-22.
17. McGahan C. Practical guide to use of antibiotics during soft tissue surgery. Veterinary Nursing Journal. 2010; 25 (9): 29-31.
18. Costa AC, Santa-Cruz F, Ferraz AA. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? Arquivos Brasileiros de Cirurgia Digestiva. 2021; 33 (4): e1558. doi: /10.1590/0102-672020200004e1558
19. Verwilghen D, Singh A. Fighting surgical site infections in small animals Are we getting anywhere? Veterinary Clinics of North America: Small Animal Practice. 2015; 45 (2): 243-276. http://dx.doi.org/10.1016/j.cvsm.2014.11.001
20. Nelson LL. Surgical site infections in small animal surgery. Veterinary Clinics: Small Animal Practice. 2011; 41 (5): 1041-1056. doi:10.1016/j.cvsm.2011.05.010
21. Dumas SE, French HM, Lavergne SN, Ramirez CR, Brown LJ, Bromfield CR, Garrett EF, French DD, Aldridge BM. Judicious use of prophylactic antimicrobials to reduce abdominal surgical site infections in periparturient cows: part 1–a risk factor review. Veterinary Record. 2016; 178 (26): 654-660. doi: 10.1136/vr.i103677
22. Verwilghen D, Weese JS. Complications associated with surgical site infections. In: Rubio-Martinez LM, Hendrickson DA (eds). Complications in equine surgery. Wiley Blackwell 2021; 168-195.
23. Southwood LL. Surgical antimicrobial prophylaxis: current standards of care. Equine Veterinary Education. 2023, 35 (11): 607-16. doi: 10.1111/eve.13864
24. Anonymous. The Swedish veterinary association’s guidelines for the clinical use of antibiotics in the treatment of horses. 2013. Available online at: https://www.svf.se/media/tztkij4b/guidelines-antibiotics-in-horses.pdf.
25. Barie PS. Modern surgical antibiotic prophylaxis and therapy—less is more. Surgical Infections. 2000; 1 (1): 23-29.
26. Sartelli M. Antibiotic therapy in surgery. 2016. Available online at: https://www.linkedin.com/pulse/antimicrobial-therapy-surgery-massimo-sartelli
27. Anonymous. Antibiotics in surgery. Available online at: https://infectionsinsurgery.org/2174-2/.
28. McHugh SM, Collins CJ, Corrigan MA, Hill AD, Humphreys H. The role of topical antibiotics used as prophylaxis in surgical site infection prevention. Journal of Antimicrobial Chemotherapy. 2011; 66 (4): 693-701. doi:10.1093/jac/dkr009
29. Hayes G, Moens N, Gibson T. A review of local antibiotic implants and applications to veterinary orthopaedic surgery. Veterinary and Comparative Orthopaedics and Traumatology. 2013; 26 (4): 251-259. doi:10.3415/VCOT-12-05-0065
30. Boothe DM, Boothe HW. Antimicrobial considerations in the perioperative patient. Veterinary Clinics: Small Animal Practice. 2015; 45 (3): 585-608. doi: http://dx.doi.org/10.1016/j.cvsm.2015.01.006
31. Streppa HK, Singer MJ, Budsberg SC. Applications of local antimicrobial delivery systems in veterinary medicine. Journal of the American Veterinary Medical Association. 2001; 219 (1): 40-48.
32. Mueller TC, Loos M, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D, Friess H, Kleeff J, Bader FG. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbeck's Archives of Surgery. 2015; 400: 167-181. doi: 10.1007/s00423-015-1279-x
33. Howe LM, Boothe HW. Antimicrobial use in the surgical patient. Veterinary Clinics: Small Animal Practice. 2006; 36 (5): 1049-1060. doi: 10.1016/j.cvsm.2006.05.001
34. Ahmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA, Reed M. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. British Medical Journal Open. 2019; 9 (9):e029727. doi:10.1136/ bmjopen-2019-029727
35. Suleiman AS, Abbass M, Hossain M, Choudhary P, Bhattacharya P, Islam MA. Impact of antibiotic-coated sutures on surgical site infections: a second-order meta-analysis. International Journal of Surgery. 2024; 110 (1): 507-519. doi: http://dx.doi.org/10.1097/JS9.0000000000000822
36. Dhole S, Mahakalkar C, Kshirsagar S, Bhargava A. Antibiotic prophylaxis in surgery: current insights and future directions for surgical site infection prevention. Cureus. 2023; 15 (10): e47858. doi: 10.7759/cureus.47858