Surgical prophylaxis: the evolution of guidelines in an era of cost containment.

Postoperative infections account for a large proportion of hospital-acquired infections, are associated with a high morbidity and mortality, and place a large burden upon the inpatient healthcare budget. Prophylaxis is desirable and is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis and postoperative wound care. There is considerable evidence that antibiotics are used excessively and inappropriately in the prevention and treatment of hospital-acquired infections, including surgical-site infections. In the case of the latter, timing of prophylaxis is crucial to success yet antibiotics are often administered at the wrong time or for too long a period, with implications for the cost of patient care. Several studies have shown that the local implementation of practice guidelines can yield significant improvements in antibiotic use and the cost of surgical prophylaxis. More rational use of antibiotics is likely to benefit the treatment of future surgical patients by reducing the pressure to select for antibiotic-resistant bacterial pathogens.