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Superficial incisional: Involving the skin and subcutaneous tissues
Deep incisional: Involving the deeper soft tissues of the incision, such as muscle or fascia
Organ/Space Involving any part of the anatomy other than the incised body layers (skin, fascia and muscle layers)
Common Principles for Surgical Prophylaxis 5
Ideally, an antimicrobial agent for surgical prophylaxis should:
- Prevent SSI
- Prevent SSI and SSI-related morbidity and mortality
- Reduce the duration and cost of health care (when the costs associated with the management of SSI are considered, the cost-effectiveness of prophylaxis becomes evident)
- Produce no adverse effects
- Have no adverse consequences for the microbial flora of the patient or the hospital
To achieve these goals, an antimicrobial agent should be:
- active against the pathogens most likely to contaminate the surgical site
- given in an appropriate dosage and at a time that ensures adequate serum and tissue concentrations during the period of potential contamination
- administered for the shortest effective period to minimize adverse effects, the development of resistance, and costs
Causative Agent
According to Infectious Disease Advisor Gram-positive bacteria such as Staphylococcus aureus are the most common causative skin-dwelling microorganisms.6
According to the Sanford Guide 2020,10 Spectrum of First Generation Cephalosporins include 7
| Gram +ve | Gram -ve | ||
|---|---|---|---|
| Staph. aureus (MSSA) | ++ | + | Klebsiella spp |
| Coagulase-Negative Staph. | ++ | + | E. coli |
| Strep. Group A,B,C & G | + | + | Proteus mirabilis |
| Strep. Pneumoniae | + | ||
| ++ = Recommended | + = Active |
Prevalence Of SSI (In Obstetrics/Gynaecological Surgeries)
According to Australian and New Zealand Journal of Obstetrics and Gynaecology;
Up to 10% of gynaecological patients undergoing an operative procedure will develop a surgical site infection.8
Guidelines for Surgical Prophylaxis
- As per journal of Chemotherapy cephalosporins are considered to be the drug of choice, because they offer fewer allergic reactions.9
- According to Surgical Antimicrobial Clinical Guidelines by South Australia Health Department: 1st Generation Cephalosporin is recommended for Prophylaxis in Surgeries like Breast Surgeries, Splenectomy, Herniorrhaphy and Abdominal Surgeries10
- According to Australian and New Zealand Journal of Obstetrics and Gynaecology: narrow-spectrum first-generation cephalosporins are to be used in preference to later generation agents, such as ceftriaxone, because the latter are strong drivers of resistance in gram-negative bacteria and have less activity against Staphylococci, a common cause of postoperative wound infection.8
- According to Society of Obstetricians and Gynaecologists of Canada The choice of antibiotic should be a single dose of a first generation cephalosporin for multiple Gynaecological surgeries including hysterectomy, pelvic organ prolapses and/or stress urinary incontinence etc.11
- According to The Journal of Obstetrics and Gynaecology of India First-generation cephalosporins seem to be the drug of choice which fit the criteria listed earlier. Use of third generation cephalosporins may be unnecessary. The threat of the emergence of resistant organisms persists.12
According to WHO Cefradine (Velosef) is categorized as ACCESS list Antibiotic while 3rd Generation Cephalosporins including Ceftriaxone are categorized as WATCH list antibiotics as they have higher resistance development potential 13
PEAK SERUM LEVEL µg/ml
References:
- Velosef Data Sheet, NCDS, Version Number 05, Version Date: 13th February 2020
- IMS MIP S1-2021
- Surgical Site Infection (SSI) | HAI | CDC ; 24 Nov 2010
- Steiner HL; American Journal of Obstetrics & Gynecology ; 121-128; Aug 2017
- Bratzler DW; American journal of health-system pharmacy;2013;70;195-283
- Rabih Darouiche; Surgical site infections - Infectious Disease Advisor ; Webpage Accessed on 10-Nov-2020
- David N et al : The Sanford Guide 50th edition 2020
- CLIFFORD V.; Australian and New Zealand Journal of Obstetrics and Gynaecology;412-419 2012.
- S. Geroulanos;Journal of Chemotherapy;2001;13;23-26
- Surgical Antimicrobial Prophylaxis Clinical Guideline; SA Health; 2017
- REAFFIRMED SOGC CLINICAL PRACTICE GUIDELINE| VOLUME 40, ISSUE 11, E747- E787, NOVEMBER 01, 2018.
- Hegde C. V.; The Journal of Obstetrics and Gynaecology of India March–April 2013 632:77– 79.
- WHO released aWaRe list 2019
