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A single preop antibiotic dose may be sufficient to prevent infection

Surgical site infections occurred in 2% of patients who received 24-hour antibiotics and in 2.1% of those treated with a single prophylactic dose.

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Applying a single dose of antibiotics before proceeding with surgery appears as effective for preventing surgical site infection as a 24-hour dosing regimen, according to a study by researchers in Brazil. The reduced use of antibiotics may also help lower surgical costs, the study authors said.

Silvia Nunes Szente Fonseca, MD, MPH, and colleagues at Hospital São Francisco, Ribeirão Preto in São Paolo, compared infection rates before and after implementing a one-dose prophylactic antibiotic protocol for patients undergoing several types of surgeries, including orthopedic, gastrointestinal and oncologic procedures.

The single-dose antibiotic protocol involves 1 g cephazolin administered during anesthetization. Surgeons approved the new protocol before it was implemented, and the surgical and medical staffs were also educated about it, according to a press release announcing the study findings.

Overall, 12,299 patients were included in the study. Of these, 6,140 consecutive patients, treated between February 2002 and October 2002, received 24-hour prophylactic antibiotics. The second group included 6,159 consecutive patients treated between December 2002 and August 2003, following the implementation of the one-dose antibiotic protocol, according to the study, published in Archives of Surgery.

The correct antibiotic protocol was followed in 6,123 (99%) of the 6,159 single-dose antibiotic patients. The researchers found that rate of surgical site infections did not significantly change after initiating the single-dose antibiotic protocol. Surgical site infection occurred in 127 (2%) 24-hour antibiotic patients and in 133 (2.1%) single-dose antibiotic patients, according to the release.

In addition, "The number of cephazolin vials purchased monthly decreased from 1,259 to 467 with a corresponding monthly savings of $1,980," the authors said.

"We previously described the successful implementation of an antibiotic prophylaxis program in our hospital, discontinuing prophylactic antibiotic usage after 24 hours and correcting the timing of the first dosage," the authors said in the release. "We decided to reduce all antibiotic prophylaxis to one dose because this measure could safely promote savings for our institution.

"We were able to demonstrate that one-dose prophylaxis is feasible," they added. "In this era of restricted hospital budgets and increased bacterial resistance, one-dose prophylaxis may provide a way to improve performance by lowering costs."

For more information:

• Fonseca SNS, Kunzle SRM, Junqueira MJ, et al. Implementing a 1-dose antibiotic prophylaxis for prevention of surgical site infection. Arch Surg. 2006;141:1109-1113.