Prophylactic antibiotics in vascular surgery. Topical, systemic, or both? Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study. Single-dose v. short-term antibiotic therapy for prevention of wound infection in general surgery. A prospective, randomized double-blind trial. [Antibioprevention in reconstructive arterial surgery. A double-blind study]. Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury. Prophylactic antibiotics in surgery for chronic ear disease. Prophylactic vancomycin versus placebo in arterial prosthetic reconstructions. The role of prophylactic antibiotics in middle ear surgery. A study on phenoxymethylpenicillin prophylaxis. Single-dose peroperative antibiotic prophylaxis in gastrointestinal surgery.
A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary. In a prospective randomized double-blind study of 141 patients referred for reconstructive vascular surgery on the abdominal aorta and the lower extremities, placebo was compared to antibiotic prophylaxis. The prophylaxis group received three doses of a combination of methicillin, 2 g and netilmicin, 200 mg. Antibiotic prophylaxis reduced postoperative wound infections as compared to placebo, i.e. 4/69 (5.8%) vs. 12/72, (16.7%) respectively (P = 0.04). No graft infections occurred. Two cases of postoperative septicaemia were seen in the placebo group, none in the antibiotic group. Among different procedures aortic-femoral bypass operations showed the highest wound infection rates. The two treatment groups were comparable with regard to all other postoperative complications registered, including nephro- and ototoxicity. The antibiotic regimen was considered safe, but had only marginal value as prophylaxis in vascular reconstructive surgery on the abdominal aorta and the lower extremities. To investigate the effectiveness of a single-dose antibiotic regimen for preventing postoperative wound infection, a prospective, randomized double-blind trial was carried out in patients undergoing "clean-contaminated", "contaminated" or "clean" (vascular) surgery. Both elective and emergency operations were included. Single-dose (preoperative) prophylaxis was compared with short-term prophylaxis (1 dose preoperatively and 2 doses postoperatively). The antibiotics were penicillin, tobramycin and metronidazole in various combinations, and comparisons between single-dose and short-term prophylaxis were made with all the regimens. The incidence of wound infection was 5/277 (1.8%) in the short-term group and 9/287 (3.1%) in the single-dose group. The difference was not statistically significant. Nor was statistically significant difference found when the type of operation and the degree of contamination were considered. Single-dose antibiotic prophylaxis thus gave a low incidence of postoperative wound infection, even in "clean-contaminated" or "contaminated" cases. Routine antibiotic prophylaxis in reconstructive vascular surgery was established on a small number of controlled trials. A comparative double-blind study of cefazolin versus placebo was conducted in 179 patients who underwent reconstructive vascular surgery over a 23 month period. The surgical procedures were divided in three groups: aorto-iliac reconstructions (112 cases) infra-inguinal reconstructions (50 cases), extra anatomic by-passes (17 cases). The arterial diseases encountered and the systemic and local conditions in favour of infection were equal in the 2 randomized groups. Among the 93 patients who received cephazolin, 13 (13.97%) developed an infection which was systemic in 1 case and local in 12 cases; 1 amputation and 1 death were observed in this group. In the placebo group 26 patients among 86 (30.23%) developed an infection, systemic in 4 cases and local in 22 cases with 1 death and 1 amputation. Statistical analysis (chi-square test) showed a significant difference in favour of the active substance. A short time massive dose of antibiotic administered in the perioperative period is the best method to reduce the incidence of infection in this type of surgery. A randomized prospective double-blind trial was conducted to determine the effectiveness of cephalothin vs. placebo given perioperatively for prevention of infections associated with operations using skin grafts for clean reconstructive surgery following burn injury. The antibiotic was effective in reducing infection (0.8% vs. 5.7%, p less than 0.03), reducing graft loss (p less than 0.2), and shortening hospital stay (12.38 days vs. 13.66 days, p = 0.02). Factors not associated with greater graft infection included the operating surgeon, the use or nonuse of a tie-on stent, graft thickness, large size of graft, and patient age. The role of prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with regard to the benefit obtained from the use of prophylactic antibiotics in surgery for chronic otitis media. The current study was designed to evaluate the role of prophylactic antibiotics in the outcomes of surgery for chronic ear disease. It was the authors' impression that there was no indication for prophylactic antibiotics in such surgery.
                Randomized prospective study performed in a tertiary care facility.
                Patients who met inclusion criteria (n = 146) were randomly assigned to an antibiotic treatment group or a control group receiving no prophylactic antibiotics. Patients in the antibiotic treatment group were given preoperative intravenous antibiotics followed by oral antibiotics for 5 days after surgery. Patients were followed postoperatively and observed for clinical evidence of infection and graft failure.
                There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival.
                The use of prophylactic antibiotics in surgery for chronic ear disease cannot be recommended based on the findings of this study. Vascular reconstructive surgery with the placement of prosthetic material caudal to the diaphragm is occasionally associated with postoperative wound infection. These infections often lead to amputation and can be lethal. Only a few published reports contain information on the value of prophylactic antibiotic treatment with these operations, but its use is common throughout the world. To investigate this problem, a prospective, double blind, randomized study of vancomycin versus placebo in 128 vascular graft operations caudal to the diaphragm was conducted from June, 1982 to July, 1984. The difference in infection rate was significant (2 p = 0.0008) in favor of the vancomycin group. Fourteen wound infections (21.2%) were found in the placebo group, 3 of which (4.5%) were prosthesis infections. Among the 62 vancomycin-treated patients, one case of superficial wound infection (1.6%) and no cases of prosthesis infection were found. The most common pathogen was Staphylococcus aureus. The study has demonstrated that vancomycin, a narrow spectrum antibiotic, in an ultra-short regimen (one gram one hour before surgery and one gram 4 hours later) is an effective prophylactic agent against postoperative wound infection. Temporary and, in most cases, doses-related side effects were seen in 7.9% of the patients treated with vancomycin. A randomized prospective double-blind study was performed testing the value of phenoxymethylpenicillin in conjunction with middle ear surgery. The patients were evaluated for clinical signs of infection and with bacteriologic cultures both pre- and postoperatively. No difference in clinical signs of infection was noted between the pre- and postoperative evaluations. A significantly larger number of patients, however, presented with postoperative positive bacteriologic cultures as compared with the preoperative cultures. This increase was particularly evident in the placebo group. The two microorganisms that were found in increased numbers postoperatively were Staphylococcus epidermidis and Pseudomonas strains. The value of prophylactic antibiotic treatment and phenoxymethylpenicillin treatment in particular is discussed. A single intravenous dose of tobramycin and lincomycin, given at the start of gastrointestinal operations, significantly reduced the incidence of postoperative wound infection from 34% to 5%. The occurrence of both anaerobic and aerobic bacteria was reduced. Therapeutic concentrations of the antibiotics were maintained throughout the operative period in most cases. No toxic effects of the antibiotics were detected, no anaesthetic complication occurred, and resistant strains of bacteria normally sensitive to the antibiotics were not isolated from wounds.
There is clear evidence of the benefits of prophylactic broad spectrum antibiotics. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.