In otolaryngology at present, evidence-based medicine (EBM) has not yet been considered for antimicrobial prophylaxis. In this study, we examined the surgical site infection (SSI) rate based on the Center for Disease Control and Prevention (CDC) Guidelines and reviewed antimicrobial prophylaxis related to surgery.
Subjects were 345 patients with CDC surgical wound classes I to III. Prophylactic antimicrobial agents were intravenously administered preoperatively. Postoperative administration days, wound conditions and general medical conditions of patients were entered in the SSI Surveillance Data Sheet. In principle, we aim to end the administration of prophylactic antimicrobial agents two days after surgery.
The overall SSI rate was 5.5% and by wound class, the SSI rate was 5.1% in Class I, 3.6% in Class II and 28.0% in Class III. The SSI rate of patients to whom administration of antimicrobial agents was ended within two days after surgery was 0.4%, while that of the patients to whom antimicrobial agents were administered for three days or more was 12.6%. Regarding types of antimicrobial agent, the rate was 5.6% in the CEZ group and 4.5% in the PIPC group, showing no significant difference. There were some differences in SSI rates depending on the time required for surgery and preoperative general condition of the patient, but there were no differences depending on patients' smoking history or obesity.
It would appear that the SSI rate cannot be reduced by intra- and post-operative administration of antimicrobial agents for a longer period; rather, postoperative administration for only two days is sufficient, provided that preoperative risk factors are thoroughly removed and/or the postoperative wounds are completely controlled. Consequently, reducing the unnecessary administration of agents will alleviate the burden on patients, as well as reduce medical costs under Diagnosis Procedure Combination (DPC).
