ANTIMICROBIAL PROPHYLAXIS IN SURGERY – PROPOSED CROATIAN NATIONAL GUIDELINE 2007

  1. INTRODUCTION

  2. Surgical site infections (SSIs), i.e. infections of the incised skin or soft tissue are most common complications in surgical practice. It is estimated that around 2-5% of patients undergoing clean extra-abdominal operations and up to 20% undergoing intra-abdominal operations will develop an SSI. At the same time, prophylactic antibiotics account for around 30% of the total antibiotic consumption in hospitals, of which 40% are administered for longer period than necessary. Irrational antibiotic consumption will have a harmful effect on patients` health (possible side effects, toxic reactions and interactions with other drugs), leading to an increased bacterial resistance to antibiotics, ultimately causing a negative economic effect.
  3. THE NEED FOR NATIONAL GUIDELINES - MATRA (ISKRA) PROJECT

 

The Ministry of Health and Social Welfare of the Republic of Croatia has recognized the need to develop national guidelines for antimicrobial perioperative prophylaxis and has initiated ISKRA (Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance) project aimed at developing national guidelines for prudent use of antibiotics in several areas of medicine. This project is a part of MATRA project (Antimicrobial Resistance Surveillance in Human Health) financed by the Dutch Ministry of Foreign Affairs and is based on the cooperation between the Croatian Committee for Antibiotic Resistance Surveillance and consultants from the Netherlands and Slovakia. The goal is to help Croatia adopt EU recommendations for rational antibiotic use and bacterial resistance control. ISKRA project indirectly enables Croatia to more easily approach the European Union in the area of medicine. The implementation of this project has started in January 2006 and is planned to last until the end of 2007.

During the MATRA project meeting in December 2006, a Working Group was founded, consisting of experts from surgical and non-surgical medical fields. This Working Group has developed National Guidelines for Perioperative and Periprocedural Prophylaxis in Elective Surgery according to the AGREE (Appraisal of Guidelines for Research and Evaluation) methodology.

Members of the Surgical Antibiotic Prophylaxis Working Group, and their respective societies, committees are:

 

THE AIM OF THE GUIDELINE

These are guidelines for antimicrobial perioperative and periprocedural prophylaxis in elective surgical procedures in adult patients. They are intended primarily for anesthesiologists and surgeons. However, we must stress that antimicrobial perioperative prophylaxis is only an adjunct to a quality preparation of patient for surgical procedure, asepsis and antisepsis measures and appropriate surgical technique.