Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine
By definition, antibiotic prophylaxis (AP) is the use of antibiotics to prevent infections at the site of injury and/or surgical site. It must be administered close to the time of procedure initiation or time of injury, and based on its pharmacodynamics and pharmacokinetics.
The World Health Organization provides strong recommendations on the administration of AP. Nevertheless, AP is often used inappropriately worldwide.
In polytrauma patients, the presence of several injuries implicates multiple potential risks of infections. In these situations, antibiotics – for treatment or prophylaxis – are frequently used without a defined rationale following recommended guidelines. The difficulty of standardizing definitions and approaches leads to this heterogeneous practice.
Ideally, AP in trauma should be specifically targeted for each patient. AP should reduce the risk of infections due to injuries, decrease the selection of multi-resistant bacterial strains, and have no adverse effects.
The fear of infections must not drive AP prescription. Infections must be treated only when present, and their prevention must occur based on specific evidence-based indications.
To address this lack of precise indications, an international group of experts – representing five surgical societies around the world – has recently published in the Journal of Trauma and Acute Care Surgery a paper providing recommendations for an optimal management of AP in trauma patients.
The Global Alliance for Infection in Surgery, Surgical Infection Society Europe, World Surgical Infection Society, American Association for the Surgery of Trauma, and the World Society of Emergency Surgery participated in the realization of this important document.
A computerized search was performed in different databases (MEDLINE, Scopus, EMBASE), including citations published between January 2000 to May 2023. The grade of recommendation, defined as strong, moderate, and weak, was established, considering the Oxford model. Through the Delphi process, different issues were discussed by the experts in several rounds. After three rounds, the process led to 100% agreement on all statements.
The article suggests the recommendations regarding the use of AP in head and brain trauma, maxillofacial trauma, thoracic and abdominal trauma, open fractures, burns, and skin wounds and bites.
The authors conclude that AP must be used only when it is indicated. Its overuse has no beneficial effects on patients. On the contrary, it has several potential drawbacks. A tailored infection risk calculation for each patient should be always performed, keeping in mind that a correct source control plays a central role in infection prevention.
Global Alliance for Infections in Surgery 