Surgical intervention Recommendation Result variable Quality. Craniotomy Recommended SSI High quality (Barker 94)
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1 indications for surgical antibiotic prophylaxis. Adapted from Scottish Intercollegiate Guidelines Network. SIGN 104: Antibiotic Prophylaxis in Surgery. A national practical guideline. Edinburgh: SIGN; 2008 Surgical intervention Recommendation Result variable Quality HEAD AND NECK Intracraneal Craniotomy SSI High quality (Barker 94) Cephalorachidian fl uid derivation SSI Infection derivation High quality (Haines 94, Langley 93) Spinal surgery SSI High quality (Barker 02) Ophthalmic Cataract surgery Highly recommended Endophthalmitis High quality (Endophthalmitis Study Group 07) Glaucoma or corneal graft from cataract surgery High quality (Endophthalmitis Study Group 07) Tear duct surgery SSI Low quality (Vardy 00) Eye-penetrating wound Endophthalmitis High quality (Narang 03, Soheilian 07) Facial Mandibular fractures (duration not > 24 hours) SSI High quality (Zallen 75, Abubaker 01, Andreasen 06) Oral bone grafts There was no direct comparison between antiobiotic and non-antibiotic proiphylaxis High quality (Lindeboom 06) Orthognathic surgery Duration of prophylaxis should not > 24 hours. Appropriate broad-spectrum antibiotics should be administered for oral fl ora. SSI High quality (Baqain 04, Bentley 99, Fridrich 94, Zijderveld 99)
2 HEAD AND NECK (cont.) Facial surgery (clean) Facial plastic surgery Must be considered Effectiveness is inferred from evidence from other that involve the insertion of a prosthesis Benign otorhinolaryngology Ear surgery (clean / cleancontaminated) No subgroup analysis was done for clean and clean-contaminated surgery High quality (Verschuur 04) Nasal surgery, paransal sinus surgery, and endocopic sinus surgery Complex septorhinoplasty (including graft) High quality (Annys 00) Prophylaxis should not last for > 24 hours High quality (Andrews 06) Tonsillectomy No studies were identifi ed that showed evidence of the effectiveness of prophylaxis Adenoidectomy (by curettage) High quality (Sánchez-Carrión 06) Insertting drainage tubes Otorrrhœa High quality (Nawasreh 04, Zipfel 99) Head and neck Head and neck surgery (clean, benign) Head and neck surgery (clean, malign, neck dissection) Very low quality (Johnson 87, Simo 06) Must be considered SSI Low quality (Coskun 00, Seven 04)
3 HEAD AND NECK (cont.) Head and neck surgery (contaminated / clean-contaminated) THORAX Prophylaxis time should not exceed 24 hours Give broad-spectrum antibiotics to cover ærobic and anærobic organisms SSI High quality (Becker 79, Dor 73, Johnson 84, Velanovich 91) Low quality (Avery 06, Coskun 00) Very low quality (Simo 06) Breast-cancer surgery Must be considered High quality (Cunningham 07) Mam moplasty Must be considered Infection after 6 weeks Low quality (Ahmadi 06) Breast surgery or implant (reconstructive or æsthetic) Effectiveness is inferred from evidence from breast-cancer surgery and other that include the insertion of a prosthesis High quality (Cunningham 07), Very low quality (Dellinger 94) Inserting a pacemaker Any infection High quality (Da Costa 98) Open-heat surgery Prophylaxis should not last for more than 24 hours SSI Low quality (Fong 79, Austin 80, Penketh 85) Low quality (Harbarth 00, Eagle 04, Zanetti 01) Lung re-section Infection at the site of surgery High quality (llves 81, Aznar 91) UPPER GASTROINTESTINAL Œsophageal surgery Effectiveness is inferred from evidence from other clean-contaminated Very low quality (Bricard 94) Gastric and duodenal surgery SSI High quality (Evans 73, Lewis 79, Polk 69) Gastric-bypass surgery Effectiveness is inferred from evidence from other clean-contaminated
4 UPPER GASTROINTESTINAL (cont.) Small-intestine surgery from other clean-contaminated HEPATOBILIARY Bile-duct surgery SSI High quality (Meijer 90) Pancreatic surgery Effectivness inferred from evidence from biliary surgery Hepatic surgery Effectivness inferred from evidence from biliary surgery High quality (Meijer 90) High quality (Meijer 90) Open cholecystectomy SSI High quality (Meijer 90) cholecystec- Laparoscopic tomy High quality (Meijer 90) High quality (Catarci 04) LOWER GASTROINTESTINAL Appendectomy Highly recommended SSI Intra-abdominal abcesses Colorectal surgery Highly recommended SSI Intra-abdominal abcesses High quality (Andersen 05) High quality (Song 98) ABDOMEN Inguinal herniorrhaphy (inguinal / femoral, with or without mesh) High quality (Aufenacker 06, Sanchez 04) Laparoscopic inguinal herniorrahphy with or without mesh from repairing open inguinal / femoral hernias High quality (Aufenacker 06, Sanchez 04)
5 ABDOMEN (cont.) Herniorraphy (incisional, with or without mesh) from repairing open inguinal / femoral hernias High quality (Aufenacker 06, Sanchez 04) Laparoscopic / open surgery with mesh (e.g. gastric band or rectopexy) except for high-risk patients from repairing open inguinal / femoral hernias High quality (Aufenacker 06, Sanchez 04) Endoscopic diagnositc Very low quality (British Society for Gastroenterology 01) Therpeutic endoscopic (endoscopic retrograde cholangiopancreatography and endoscpoic percutaneous gastrostomy) Must be considered in high-risk patients Very low quality (British Society for Gastroenterology 01) Splenectomy except for high-risk patients High quality (Meijer 90) Gynæcology Abdominal hysterectomy Vaginal hysterectomy Pelvic infection High quality (Allen 72, Ledger 73) Cæsarean Highly recommended SSI High quality (Smaill 05) Assisted birth High quality (Liabsuetrakul 04) Perineal tear Manual placenta removal for 3 rd - and 4 th -degree tears that affect the anal sphincter or the rectal mucosa for patients with infection due to chlamnydia or gonorrhœa SSI Very low quality (RCOG 01) Very low quality (WHO 00)
6 ABDOMEN (cont.) Induced abortion Highly recommended Infection of the upper genital tract High quality (Sawaya 96) Evacuating an incomplete abortion High quality (May 05) Inserting intra-uterine device High quality (Grimes 99) Urogenital Transrectal prostate biopsy Bacteriuria Higfh quality (Crawford 82, Ruebush 79) Shockwave lithotripsy Urinary-tract infection High quality (Pearle 97) Percutaneous nephrolithotomy for patients with calculi 20 mm, or with pyelocaliceal dilation Urosepsis High quality (Mariappan 06) High quality (Mariappan 06) Endoscopic removal / fragmentatio of ureteral calculus Bacteriuria Post-operative fever High quality (Knopf 03) Calidad baja (Takahashi 05) Transurethral resection of the prostate Highly recommended Bacteriuria Infectious complications High quality (Berry 02) Transurethral resection of bladder tumours Very low quality (Delavierre 93) Radical cystectomy SSI high after cyctectomy Very low quality (Takeyama 05) EXTREMITIES Arthroplasty Highly recommended In addition to endovenous antibiotics, antibiotic cement is recommended Consideration should be given to antibiotic prophylaxis for up to 24 hours Hip infection Joint infection High quality (Hill 81, Lidwell 82) Low quality (Block 05, Engesaeter 03) Low quality (Block 05, Engesaeter 03) Open fracture Highly recommended SSI High quality (Gosselin 04)
7 EXTREMIDADES (cont.) Open surgery to repair a closed fracture Highly recommended Deep infection of the surgical wound High quality (Gillespie 00) Hip fracture Highly recommended Deep infection of the surgical wound High quality (Southwell 04) Orthopædic surgery (without implants) from clean-contaminated Amputation of lower limb SSI High quality (Sonne 85) Vascular surgery (abdominal arterial reconstruction and reconstruction of the lower extremities SSI High quality (Stewart 07) Surgery of soft tissues of the hand from orthopædic and vascuar surgery High quality (Gosselin 04, Gillespie 00) NON-SURGICAL INTERVENTIONS Intravascular catheter insertion: non-tunnelled central venous catheter tunnelled central venous catheter Very low quality (O Grady 02) High quality (van de Wetering 05) GENERAL Clean-contamniated when no specifi c evidence is available Prosthesis insertion when no specifi c evidence is available
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