Evidence-based Medicine: Systemic Perioperative Antibiotic Prophylaxis For Prevention Of Surgical-site Infections In Plastic And Reconstructive Surgery
Kevin M. Klifto, DO, PharmD1, Alexandria C. Rydz, PharmD1, Sonali Biswas, MPHS2, Charles Scott Hultman, MD, MBA3, Detlev Erdmann, MD, PhD, MHS1, Brett T. Phillips, MD, MBA2.
1University of Missouri, Columbia, MO, USA, 2Duke, Durham, NC, USA, 3Johns Hopkins, Baltimore, MO, USA.
PURPOSE: After nearly a decade of new data, the Evidence-Based Consensus Conference Statement from the AAPS was updated for prophylactic systemic antibiotics to prevent surgical site infections (SSI). Pharmacotherapeutic concepts using antimicrobial stewardships were applied for clinical interpretation and management to optimize patient outcomes and minimize resistance.
METHODS: PRISMA, Cochrane, and GRADE certainty of evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched for randomized controlled trials (RCTs). We included patients that had Plastic and Reconstructive Surgery and were treated with prophylactic systemic antibiotics administered perioperatively (preoperative, intraoperative, postoperative). Comparisons were made between active interventions and/or non-active interventions (placebo) at different prespecified durations to determine the development of an (SSI). Meta-analyses were performed.
RESULTS: We included 138 RCTs that met eligibility criteria. RCTs consisted of 18 Breast, 10 Cosmetic, 21 Hand/Peripheral Nerve, 61 Pediatric/Craniofacial, and 41 Reconstructive studies. We further examined bacterial data extracted from studies for patients that did and did not take prophylactic systemic antibiotics for prevention of SSI. Clinical recommendations were provided using Level-I evidence.
CONCLUSION: Surgeons have long been overprescribing systemic antibiotic prophylaxis in Plastic and Reconstructive Surgery. Evidence supports antibiotic prophylaxis to prevent SSI for specific indications and durations. Prolonged antibiotic use has not been linked to reductions in SSIs and misuse may increase the bacterial diversity of infections. Greater efforts should focus on transitioning from practice-based medicine to pharmacotherapeutic evidence-based medicine.
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