EN 
ES Published in: Today Digital
Author: Dr. Claudette Díaz, Infection Control and Epidemiology Management Mr. Surgical Management and CEE of the General Hospital of the Plaza de la Salud.
One of the strategies with strong evidence to reduce the risk of SSI is the administration of prophylactic antibiotics.
Its use in the prevention of infection of the surgical site is based on:
1. Demonstration that the use of perioperative antibiotics decreases the incidence of infections.
2. The correct use of the antibiotic for prophylaxis has few effects on the microbiota or on its immunity.
3. The use of antibio-prophylaxis is accompanied by few adverse events.
4. It is an economic, cost-effective intervention.
It is necessary to develop an institutional policy with the purpose of standardizing the indication of antibiotics for prophylaxis in patients undergoing surgical procedures in order to prevent and reduce the incidence of surgical site infections and ensure the rational use of antibiotics, but the great challenge is in the fulfillment of it.
1. The choice of the antibiotic. It must be effective against the most common microorganisms that cause SSI (mainly gram-positive cocci). For most surgical procedures, the use of cefazolin (first-generation cephalosporin ev) has proven effective. Vancomycin with clindamycin should be indicated only in patients with allergy to beta-lactam antibiotics.
2. Moment of antibiotic dose: The goal of surgical antimicrobial prophylaxis is to reach levels of the drug that exceed the MIC of the microbiota present at the time of the incision (that is, when contamination occurs) and throughout the surgery. until closing (suture). The time of indication of choice is anesthetic induction (30 minutes before the surgical incision).
3. Route of administration of choice is endovenous. The use of the oral route is validated for some dental and urological procedures.
4. Dosage. By definition, antibioprophylaxis is a single dose. It is recommended to reinforce with intraoperative dose when they extend for 4 or more hours and with blood loss> 1500 ml intraoperatively.
