Antimicrobial Prophylaxis in Surgery: An International Survey

BACKGROUND: We investigated current clinical practice of antimicrobial prophylaxis (AMP) in surgery. METHODS: Survey administration of AMP to patients without co-morbidity or allergy undergoing surgery, among surgeons indexed as corresponding authors for articles published in general surgery, orthopedics, gynecology, and cardiac surgery journals. RESULTS: A total of 1,068 surgeons answered (response rate 68%). Of these, 26.1% do not begin infusion of the first antimicrobial dose within 1 h of incision, as suggested by guidelines, and 27.2% continue administering AMP for two or more days after surgery, including 7.6% who continue for four to seven days, in contradiction to the guidelines. There were significant differences between Europe and North America in the selection of AMP regimens. Furthermore, 19% of Europeans order infusion of the first antimicrobial dose during the incision compared with 3.9% of North Americans; 74.2% of Europeans discontinue AMP within 24 h after surgery compared with 86% of North Americans. Finally, 31% of general surgeons in North America administer supplementary oral prophylaxis for colectomy compared with only 5% of European surgeons. CONCLUSIONS: The AMP strategies in day-to-day self-reported practice differ significantly. Uniform, evidence-based practice is warranted, especially in this era of increasing antimicrobial resistance.