ABSTRACT
Virtually all surgical operations involve disruption of the cutaneous barrier, which exposes the patient to Staphylococcus and Streptococcus species. For most operations, a single dose of a first-generation cephalosporin such as cefazolin provides adequate coverage to prevent infection by these bacteria at the surgical site. Disruption of the intestinal mucosa during surgery necessitates broader antibiotic coverage for aerobic Gram-negative bacilli and anaerobic bacteria. Cephalosporins such as cefoxitin or cefotetan are often recommended because of their activity against both enteric aerobes and anaerobes, including Bacteroides fragilis. Clindamycin or metronidazole, combined with an aminoglycoside, have also been used for this purpose. ‘Expanded spectrum’ cephalosporins (e.g. ceftriaxone, ceftazidime, and others) and penicillins, (e.g. piperacillin-tazobactam, ticarcillin, and others) are generally not recommended for surgical prophylaxis because they are more expensive, have less efficient coverage for Staphylococcus, and maintain higher activity against pathogens not commonly encountered in elective surgery. Although broaderspectrum antibiotics may reduce the incidence of postoperative bacterial infections, the risk of antimicrobial resistance and development of serious fungal infections increases. Table 80.2 displays the type of surgery with the most likely pathogens and recommendations for perioperative antimicrobial therapy.
