Researchers found that antibiotic prophylaxis in clean-wound surgeries does not significantly reduce the incidence of surgical site infections (SSIs), with consideration to reevaluate its routine use. A recent retrospective study in Thailand was published in the journal of BMC Surgery. The study was conducted by Mai C. and colleagues. This study aimed to assess the benefit of antibiotic prophylaxis in prevention of SSIs following skin excision, thyroidectomy, inguinal herniorraphy, as well as other breast surgeries.
These were aseptic surgical procedures, which incorporated regional or general anesthesia to be performed for the evaluation of the SSI rates in clean wounds. In this procedure, antibiotic prophylaxis was given at the discretion of the attending surgeons since institution practices vary related to this aspect. Out of the initial list of 501 surgeries, a total number of 417 surgeries were included after excluding the 84 cases based on the reason of incompleteness. Standardized criteria defined SSI, and medical records and reports from the infection control unit were abstracted for data. The study analyzed risk factors for infection by applying propensity score weighting to balance covariates between the groups of patients who received antibiotics and those who did not.
• A total of 417 surgeries were involved with 233 patients receiving prophylaxis antibiotics, and 184 not receiving prophylaxis.The SSIs rate among the patients who received the prophylactic antibiotics was at 1.3% while that of patients not receiving the antibiotics was slightly at 2.2%.
• The study used propensity scoring-based inverse probability treatment weighting and found that in terms of SSI, both the groups were not statistically significant when in comparison with each other (risk ratio [95% confidence interval]: 0.54 [0.11, 2.50]; p = 0.427)
• The research showed that in the given environment, there was no significant reduction of the risk of SSIs using antibiotic prophylaxis in clean-wound surgeries.
This study concluded no statistically significant difference in the rates of SSIs for patients who were, and were not, given antibiotic prophylaxis during common clean-wound surgeries. These results may indicate that routine antibiotic prophylaxis has no role in such cases and existing recommendations should be reassessed to prevent patients from being driven into unnecessary antibiotic use without posing risks to their health condition. More research must be set up to fine-tune the prophylactic use of antibiotics so as to ensure it can be used only when it serves to have positive utility.
Reference:
Charernsuk, M., Tunruttanakul, S., Jamjumrat, L., & Chareonsil, B. (2024). Evaluation of preoperative antibiotic prophylaxis in clean-wound general surgery procedures: a propensity score-matched cohort study at a regional hospital. BMC Surgery, 24(1). https://doi.org/10.1186/s12893-024-02616-8