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  Vol. 128 No. 1, January 1993 TABLE OF CONTENTS
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  PAPERS PRESENTED AT THE 12TH ANNUAL MEETING OF THE SURGICAL INFECTION SOCIETY, LOS ANGELES, CALIF, APRIL 9, 1992
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Antimicrobial Prophylaxis for Surgical Wounds

Guidelines for Clinical Care

Carey P. Page, MD; John M. A. Bohnen, MD; J. Raymond Fletcher, MD; Albert T. McManus, PhD; Joseph S. Solomkin, MD; Dietmar H. Wittmann, MD, PhD

Arch Surg. 1993;128(1):79-88.


Abstract



• Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce the overall costs attributable to infections. Principles of prophylaxis include providing effective levels of antibiotics in the decisive interval, and, in most instances, limiting the course to intraoperative coverage only. Use in The National Research Council clean contaminated operations is appropriate and, in many instances, has been proven beneficial. Antibiotic prophylaxis is also indicated for clean operations, such as those involved with insertion of prosthetic devices, that are associated with low infection risk and high morbidity. Extension of antibiotic prophylaxis to other categories of clean wounds should be limited to patients with two or more risk factors established by criteria in the study of the efficacy of nosocomial infection control (SENIC) because the baseline infection rate in these patients is high enough to justify their use. Cefazolin (or cefoxitin when anaerobic coverage is necessary) remains the mainstay of prophylactic therapy. Selection of an alternate agent should be based on specific contraindications, local infection control surveillance data, and the results of clinical trials. Newer criteria for determining the risk of "site infection" (wound and intracavitary) are in evolution and may lead to modification of these recommendations over the next several years.

(Arch Surg. 1993;128:79-88)



Author Affiliations



From the Departments of Surgery, The University of Texas Health Science Center, San Antonio (Dr Page); University of Toronto, Ontario (Dr Bohnen); University of South Alabama, Mobile (Dr Fletcher); Microbiology Branch, US Army Institute of Surgical Research, Fort Sam Houston, Tex (Dr McManus); University of Cincinnati College of Medicine, Ohio (Dr Solomkin); and Medical College of Wisconsin, Milwaukee (Dr Wittmann).


Footnotes



Accepted for publication July 25, 1992.

Reprint requests to Department of Surgery, The University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284-7842 (Dr Page).



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