A Questionnaire Survey on the Theory of Postoperative Infection Prophylaxis

Nagao Shinagawa, Keiji Mashita, Shigetomi Iwai¹⁾, Takashi Yokoyama²⁾ and Hiromitsu Takeyama³⁾

The Department of Surgery, Nagoya City Koseiin
¹⁾The Third Department of Surgery, Nihon University, School of Medicine
²⁾The Department of General Medicine, Hiroshima University, School of Medicine
³⁾The First Department of Surgery, Nagoya City University Medical School

A questionnaire survey on the theory of postoperative infection prophylaxis was conducted to obtain the consensus on perioperative antimicrobial use among surgeons in Japan in the period from April to September 1999. Eighty-eight of the 133 surgeons replied, and the following consensus was obtained. The aim of perioperative antimicrobial use is to prevent not only surgical site infection but postoperative remote infections, such as respiratory and urinary tract infections. A prophylactic antimicrobial agents should be chosen based on their efficacy against the pathogens expected to be contaminants, such as Staphylococcus spp., E. coli, K. pneumoniae, and Bacteroides fragilis group. The most commonly used agents are the penicillins and first and second generation cephalosporins. The timing and duration of prophylaxis are very important issues. The optimal strategy for most commonly used agents entails infusion of the first dose between approximately 30 minutes pre and post-skin incision and additional intraoperative dosing for operations whose duration exceeds the estimated serum half-life. An additional 1 day cover for clean operations and 3 days cover for contaminated operation are supported. Vancomycin should not be used routinely as a prophylactic agent. However, it should be given prophylactically to cover operations in colonized patients, following a discussion with an infection control physician. In addition, prophylaxis with vancomycin should be considered for patients undergoing high risk operation. Although a consensus was obtained in regard to the above states, there was no agreement on preoperative oral antibiotic prophylaxis for colon surgery.

Key words
postoperative infection, antibiotic prophylaxis, surgical site infection

Reprint requests
Nagao Shinagawa The Department of Surgery, Nagoya City Koseiin 2-1501 Sekobo, Meitou-ku, Nagoya, 465-8610 JAPAN

Accepted
April 26, 2000

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