Antibiotic prophylaxis in clean surgery: peripheral vascular surgery, noncardiovascular thoracic surgery, herniorrhaphy, and mastectomy.

Studies published in the English-language literature on the use of prophylactic systemic antibiotics in vascular surgery, noncardiovascular thoracic surgery, mastectomy, and herniorrhaphy were reviewed. The effectiveness of antibiotic prophylaxis in preventing deep and superficial wound infections in peripheral vascular surgery appears to be well documented, especially if prophylaxis is directed against Staphylococcus aureus. In clean thoracic surgery the evidence is equivocal, and no studies have sufficient statistical power to eliminate the possibility even of a 50% reduction in incidence. In herniorrhaphy and mastectomy some evidence from a much more powerful study suggests that antibiotic prophylaxis may result in a decrease of up to 50% in wound infections, but whether these data can be generalized uncritically to all clean wounds is still a matter of debate. Accordingly, only guarded recommendations can be made regarding the use of prophylactic antibiotics in procedures associated with a very low risk of serious infection.