Vilar-Compte Diana, García-Pasquel María José
Departamento de Infectología, Instituto Nacional de Cancerología, Tlalpan, México.
Rev Invest Clin. 2011 Nov-Dec;63(6):630-40.
The effectiveness of perioperative antibiotic prophylaxis in reducing surgical site infections has been demonstrated. Its utility is recognized for clean-contaminated procedures and some clean surgeries. Prophylactic antibiotics are used as intended to cover the most common germs in the surgical site; first and second generation cephalosporins are the most used. For optimal prophylaxis, an antibiotic with a targeted spectrum should be administered at sufficiently high concentrations in serum, tissue, and the surgical wound during the time that the incision is open and risk of bacterial contamination. The infusion of the first dose of antimicrobial should begin within 60 min before surgical incision and should be discontinued within 24 h after the end of surgery The prolonged use of antibiotic prophylaxis leads to emergence of bacterial resistance and high costs. The principles of antimicrobial prophylaxis in cancer surgery are the same as those described for general surgery; it is recommended to follow and comply with the standard criteria. In mastectomies and clean head and neck surgery there are specific recommendations that differ from non-cancer surgery. In the case of very extensive surgeries, such as pelvic surgery or bone surgery with reconstruction, extension of antibiotics for 48-72 h should be considered.
围手术期抗生素预防在降低手术部位感染方面的有效性已得到证实。其在清洁-污染手术和一些清洁手术中的作用已得到认可。预防性抗生素按预期用于覆盖手术部位最常见的病菌；第一代和第二代头孢菌素是最常用的。为实现最佳预防效果，应在切口开放且存在细菌污染风险期间，在血清、组织和手术伤口中以足够高的浓度给予具有靶向抗菌谱的抗生素。首剂抗菌药物应在手术切口前60分钟内开始输注，并应在手术结束后24小时内停用。抗生素预防的长期使用会导致细菌耐药性的出现和高成本。癌症手术中抗菌预防的原则与普通手术中描述的原则相同；建议遵循并符合标准规范。在乳房切除术和清洁的头颈手术中，有一些与非癌症手术不同的具体建议。在非常广泛的手术中，如盆腔手术或有重建的骨手术，应考虑将抗生素使用时间延长48 - 72小时。
