Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

Dirty:encountered or there is visible contamination of the wound, suchas gross spillage from a hollow viscus during the operation orcompound/open injuries operated within four hoursoperations in the presence of pus or where there is a previouslyperforated hollow viscus, or compound/open injuries more thanfour hours old.Emergency contaminated or dirty operations call for antibiotic therapy rather thanprophylaxis and are thus beyond the scope of this guideline.Insertion of prosthetic devicesThe insertion of a prosthetic device increases the risk of wound infection and SSIbecause it reduces the host’s defences 34 . Where a prosthetic device is present even alow bacteria count is sufficient to cause infection. Antibiotic prophylaxis is normallyrecommended for surgery involving the insertion of prosthetic devicesLength of preoperative hospital stayIn the first 48 hours of his or her stay in hospital the patient’s skin is graduallycolonised by nosocomial bacterial strains 25 , particularly if he or she is receivingantibiotics as therapy. These strains are often antibiotic-resistant and may causecontamination during the operation, encouraging the onset of multi-resistant germassociatedSSI and increasing the length of postoperative hospital stay 35 .For this reason it is important to limit the preoperative stay; where this is not possibleor when subsequent operations are performed during the same stay, this must betaken into account when choosing an antibiotic for prophylaxis 23 .Duration of surgeryThe duration of each operation is directly correlated with the risk of wound infectionand this risk is additional to that of the class of operation 32 . In a study by Culver and