[Evidence-based medicine in antimicrobial surgical prophylaxis].
BACKGROUND
The main objective of antibiotic prophylaxis in surgery is to reduce morbidity and mortality associated with wound infection, which has a favorable impact on quality of care and overall health-care costs. The bases of antibiotic prophylaxis have been known for decades, but the appearance of new pharmacological agents, alternative routes of administration, modern surgical procedures, and previously unknown antimicrobial resistances involve the need for reviewing these bases.


OBJECTIVE
To re-evaluate some of the general principles of the use of antibiotic prophylaxis in surgery and highlight the quality of the evidence supporting our clinical decisions found in the literature.


METHODS
Review of the literature with special attention to prospective, randomized, evidence-based clinical trials on the need for antibiotic prophylaxis in surgery, mainly general surgery.


RESULTS
The method for demonstrating the effectiveness of an antibiotic in prophylaxis continues to be the prospective, randomized clinical trial. Evidence of the need for antibiotic prophylaxis in clean-contaminated surgery and when prosthetic materials are used is good.


CONCLUSIONS
Most studies on the general principles of prophylaxis have been carried out in general surgery and it is difficult to extrapolate their results to other fields or surgical specialties. Therefore, new clinical trials in each specialty are needed to establish specific recommendations. However, the standardization of aseptic, antiseptic, and technical procedures in surgery has produced a notable decrease in the wound infection rate compared to historical controls, so now it is difficult to demonstrate significant differences in the results of clinical trials. Finally, the response to the fundamental question of "What do we propose to prevent and to what degree?" with which the antibiotic era began is either difficult to formulate or described ambiguously when referring to advanced procedures, such as endoprostheses, endoscopic retrograde cholangiography, or dental implants.
Vega
D
D
Departamento de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid.
Tellado
J M
JM
D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004198:Disease Susceptibility; D016527:Drug Costs; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D006801:Humans; D011292:Premedication / Q000191:economics / Q000706:statistics & numerical data; D012306:Risk; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents