ABSTRACT
The prevention of surgical-site infections (SSIs) is a battle that has been waged since the first procedures were performed; the practice of trepanation, practiced from prehistorical times, finally waned during the Renaissance because of the high infection rate. SSIs have not been able to be completely eliminated despite our best efforts-only minimized. In 1961, John F. Burke's animal study demonstrating the efficacy of preexisting levels of antibiotics in the tissues prior to inoculation set the stage for widespread adoption of preincisional antibiotics. Following that was a tendency to a “more is better” philosophy, using antibiotics postoperatively as well. Over time, the lack of data for the use of postoperative antibiotic prophylaxis has largely led to the abandonment of this except in certain circumstances. The selection of prophylactic intravenous antibiotics is fairly straightforward in most patients, logically aimed at likely organisms. In patients undergoing Class I wounds, coverage is aimed toward Gram-positive bacteria.
