J Korean Med Sci.  2019 May;34(17):e135. 10.3346/jkms.2019.34.e135.

Appropriate Prophylactic Antibiotic Use in Clean Wound Surgery Under Local Anesthesia

Affiliations
  • 1Department of Plastic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. nicekek@korea.com

Abstract

BACKGROUND
Although guidelines to prevent surgical site infections (SSIs) were published more than a decade ago, prophylactic antibiotics are still used subjectively in clinical practice. In this study, we evaluated the safety of single-dose preoperative intravenous antibiotics without postoperative antibiotics in the field of clean wound surgery performed under local anesthesia. We also surveyed the present clinical conditions for prophylactic antibiotic use in the plastic surgery departments of training hospitals in Korea.
METHODS
A total of 360 consecutive patients who underwent clean wound surgery under local anesthesia in an outpatient clinic from March 2018 to October 2018 were reviewed. In the study group, a single surgeon administered first-generation cephalosporins intravenously within 1 hour of skin incision and did not prescribe additional antibiotics. In the control group, 2 other surgeons prescribed oral first-generation cephalosporins postoperatively for 2 to 3 days without preoperative antibiotics. A telephone survey about perioperative antibiotic regimens was conducted at the departments of plastic surgery in training hospitals.
RESULTS
There were 128 patients in the study group and 232 patients in the control group. There were no significant differences between the 2 groups regarding SSIs and other surgical complications. A total of 41 training hospitals answered the survey and every hospital had protocols of prescribing postoperative oral antibiotics routinely at the time of discharge with a mean duration of 3.9 days. Only 11 hospitals (26.8%) prescribed parenteral antibiotics before surgery as well as postoperative oral antibiotics.
CONCLUSION
Intravenous injection of single-dose first-generation cephalosporins 1 hour before surgery without postoperative antibiotics did not increase the incidence of SSIs compared with the usual practice of giving only postoperative antibiotics prescription for 2 to 3 days in cases of clean wound surgery performed under local anesthesia. Proper antibiotic prophylaxis should be performed by surgeons in training hospitals without hesitation.

Keyword

Antibiotics; Prophylaxis; Surgical Wound; Surgical Site Infection

MeSH Terms

Ambulatory Care Facilities
Anesthesia, Local*
Anti-Bacterial Agents
Antibiotic Prophylaxis
Cephalosporins
Humans
Incidence
Injections, Intravenous
Korea
Prescriptions
Skin
Surgeons
Surgery, Plastic
Surgical Wound Infection
Telephone
Wounds and Injuries*
Anti-Bacterial Agents
Cephalosporins
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