title: Perioperative antibiotic prophylaxis in plastic surgery: a prospective study of 1,100 adult patients.
abstract: BACKGROUND
  Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate.
  
  
  METHODS
  Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive or cosmetic procedures were enrolled. Procedures were classified into four groups, and prophylactic antibiotics were only administered perioperatively in 23.4% of cases, according to patient-related and procedure-related risk factors.
  
  
  RESULTS
  The overall SSI incidence was 1.4% (1.1% for clean surgery and 3.8% for clean-contaminated surgery). Oral oncologic surgery showed the highest infection rate (5.3%).
  
  
  CONCLUSIONS
  Specific guidelines are provided to encourage judicious use of antibiotics. Antibiotic prophylaxis is administered based on the type of operation and the patient's characteristics. No prophylaxis was carried out in superficial skin surgery and simple mucosal excisions. Antibiotic prophylaxis is always indicated in microsurgery, prosthetic surgery, incisional hernias, clean non-prosthetic osteoarticular surgery and clean-contaminated procedures such as oral cavity or genitourinary system. In clean surgery and rhinoplasty, antibiotic prophylaxis is only indicated when the operation lasts more than 3 h and/or the American Society of Anesthesiologists (ASA) score is 3 or more. With the protocol reported, the risk of infection can be kept very low, avoiding the negative effects of indiscriminate use of antibiotics.
authors.affiliation: Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro, 129, 90127 Palermo, Italy. francytoia@inwind.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Toia
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.forename: Maria Fatima
authors.initials: MF
authors.lastname: Massenti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Amodio
authors.forename: Roberto
authors.initials: R
authors.lastname: Pirrello
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome