[Perioperative antibiotic prophylaxis at the Clinic of Reconstructive Surgery of the Zurich University Hospital].

Abstract

With the goal of ensuring maximal safety, surgeons tend to apply antibiotic prophylaxis generously to patients undergoing selective operative procedures. However, the indiscriminate or inappropriate use of prophylactic antibiotics i) leads to the selection of resistant microbial organisms and ii) results in an increase in general medical treatment costs. Given this controversy, the clinic of reconstructive surgery implemented in 1999 a set of guidelines for the proper use of antibiotics. Antibiotic prophylaxis was defined as a pre- or perioperative application of antibiotics as a single to maximum triple-shot dose. It was recommended only for operations involving special risk factors or the implantation of alloplastic material. The recommended medication of choice was the widely-accepted standard first-generation cephalosporin product Cefazolin. We have carried out a quality control trial to analyse prospectively our own experience with the implementation of these guidelines and to compare results with a retrospective group of patients. A total of 792 patients (441 in the retrospective group, 351 in the prospective group) were enrolled in the study. About one third of all patients received an antibiotic prophylaxis. Of these, about 3/4 received the antibiotic prophylaxis without having one of the above-mentioned indications. We observed that 35% of all prophylaxis were given for breast surgery, followed by surgery for scar revisions and lipodystrophy. The most commonly used antibiotic was Cefuroxim rather than Cefazolin. There was no significant reduction in the general application of antibiotic prophylaxis yet apparent in the prospective group. However, there was a clear increase in the use of Cefazolin from 0.2% to 13.2%. We conclude that guidelines can be created to reduce the incidence of uninformed and inappropriate decisions, but their implementation requires time, motivation, and thorough and repeated information campaigns.