Publication:

Current perspectives on surgical antibiotic prophylaxis: guideline recommendations, prescribing patterns, antimicrobial resistance and future directions

Surgical antibiotic prophylaxis is an essential component of peri-operative infection prevention and plays an important role in reducing surgical site infections. Although guidelines and evidence-based approaches have been agreed upon on an international level, there is still a great deal of variation between healthcare institutions in the way that they prescribe, which can result in antimicrobial resistance, higher healthcare costs and morbidity among patients. This review highlights existing guidance for the use of surgical antibiotic prophylaxis (SAP), reviews the current antibiotic use trends, explores typical prescribing errors and adherence to guidelines, and explores their impact on AMR and clinical outcomes. A literature review was undertaken using international guidelines, peer-reviewed publications, surveillance reports and systematic reviews with a particular focus on antibiotic selection, timing of antibiotic prophylaxis, Duration of antibiotic prophylaxis, interventions to support antimicrobial stewardship and antibiotic prescribing practices in tertiary care, and emerging strategies to optimize SAP. There is evidence that proper implementation of the SAP guidelines lessens the risk of surgical site infections (SSIs). Inappropriate practices, such as the use of broad-spectrum antibiotics, delayed treatment and extended antibiotic coverage after surgery, however, are still common and lead to greater AMR, healthcare costs, and poor clinical outcomes. Rational antibiotic use can be achieved with antimicrobial stewardship initiatives, prescription audits, clinical pharmacist involvement, and/or electronic decision-support systems. While SAP continues to play a key role in preventing SSIs, it must be implemented in accordance with evidence-based recommendations. Enhancing antimicrobial stewardship, optimizing prescribing and implementing supportive technologies can optimize SAP, limit AMR, and improve surgical patient outcomes.