1. Žilvinas Dambrauskas, MD, PhD Department of Surgery Lithuanian University of Health Sciences 2012-10-01

4. 0% 5% 10% 15% 20% Prevalence of SSI (%) Staphylococcus aureus Coagulase-negative Staphylococcus Enterococcus spp. Escherichia coli Pseudomonas aeruginosa Enterobacter spp. 1. Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis. 2001;7:220–224. 2. American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 1999;56:1839–1888. 3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control. 1999;27:97–134.388. www.nice.org.uk/CG74

5. McDonald M et al. Aust NZ J Surg. 1998;68:388–396. Adapted with permission from Blackwell Synergy © 1998. All studies, fixed All studies, random Multi > 24h Multi < 24h Favors single dose Favors multiple dose www.nice.org.uk/CG74

6. Infections, % Hours From Incision 14/3695/699 5/1,009 2/180 1/61 1/41 1/47 15/441 0 1 2 3 4 ≤–3>–2>–101234≥5 Classen DC et al. N Engl J Med. 1992;326:281–286. Copyright © 1992 Massachusetts Medical Society. All rights reserved. www.nice.org.uk/CG74

8.  Single effective I/V dose (I A)  20-60 min before incision (induction of anaesthesia)  Second dose could be used if :  surgery > 3-4 hr  blood loss > 1500 ml  Further use of AB after 24 hr from prophylaxis is justified only in patients with high risk of septic complications (treatment only!) Calise F et al. Perioperative antibiotic prophylaxis in adults. Outline of the principal recommendations. National reference guidelines. Minerva Anestesiol. 2009 Sep;75(9):543-7, 548-52. English, Italian. PubMed PMID: 19644438. www.nice.org.uk/CG74

9. Type of Surgery Recommended AB Alternative Esophagectomy, gastrectromy Cefazolin 2 g Cefuroxime 1,5 g Stomach and/or small intestine Cefazolin 2 g Metronidazole 0.5 - 1 g Cefuroxime 1,5 g HPB surgery Cefazolin 2 g Metronidazole 0.5 - 1 g Clindamycin 600 mg Appendectomy Cefazolin 2 g Metronidazole 0.5 - 1 g Gentamycin 240 mg, Metronidazole 0.5 g Colorectal Cefazolin 2 g Metronidazole 0.5 - 1 g Gentamycin 240 mg, Metronidazole 0.5 g Penetrating trauma Penicilin 5 m, Gentamycin 240 mg, Metronidazole 0.5 g Cefuroxime 1,5 g Metronidazole 0.5 - 1 g Hernia repair Cefazolin 2 g Clindamycin 600 mg Breast surgery Cefazolin 2 g Clindamycin 600 mg

10. Indicator No. 1  % of patients, who received AB within 1 hr prior to incision Indicator No. 2  % of patients, who received AB based on the Guidelines Indicator No. 3  % of patients, who received no AB after 24 hr