BackgroundInfection of the incised skin or soft tissues is common, but can be avoided by the use of antibiotic prophylaxis in surgery. Some bacterial contamination of a surgical site is inevitable, either from the patient’s own bacterial flora or from the environment (1). The basic idea behind surgical wound prophylaxis is that antibiotics should already be in the tissue at the time the wound is inflicted. Administration of antibiotics inhibits growth of contaminating bacteria, and their adherence to tissues and to prosthetic implants, thus reducing the risk of infection (2). However antibiotics are not innocuous – apart from the cost, there is a substantial risk of allergy, up to and including death from anaphylaxis as well as development of resistance. The aim of antimicrobial prophylaxis in urological surgery is to prevent infective complications resulting from diagnostic and therapeutic procedures. There is no single-handed guideline for the use of antibiotic prophylaxis at Aker University Hospital.MethodBetween January 2004 and June 2004, 177 surgical procedures were studied at Oslo Urological University Clinic at Aker University Hospital. By reviewing medical, anaesthetic and nursing records, and medication charts, the antibiotic choice, duration of prophylaxis, dose and timing of the first dose was recorded. FindingsThe timing and duration of the antibiotic prophylaxis were incorrect in many cases. Among those who received prophylaxis, 41.5 % (39/94) were given prophylaxis after the time of incision, and the mean duration of prophylaxis was 5.2 days with a range of 0 days and 14 days. There was also a variation in the dosage and type of antibiotic used in prophylaxis for the same kind of surgeries. Interpretation The evidence on the best choice of antibiotics and prophylactic regimens is limited. Most studies in the past have been poorly designed and have lacked statistical power. Obviously, there is a need for evidence-based guidelines, in order to standardize the antibiotic prophylaxis at Aker University Hospital.
(1) Emmerson AM, Enstone, JE, Griffin M, Kelsey MC, Smyth ET. The Second National Prevalence Survey of infection in hospitals - overview of the results. J Hosp Infect 1996; 32: 175-90. (2) Tornqvist IO, Holm SE, Cars O. Pharmacodynamic effects of subinhibitory antibiotic concentrations. Scand J Infect Dis 1990; 74: 94-101.