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INTRODUCTION

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A surgical site infection (SSI) is an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure, or within 90 days if prosthetic material is implanted at surgery.1 SSIs are classified into incisional (superficial/deep) or organ/space infections (Table 110–1A).1 According to the Centers for Disease Control and Prevention (CDC), prevalence survey in 183 acute care hospitals in the United States, SSIs and pneumonia were the most common health-care-associated infections.2 Also the National Healthcare Safety Network (NHSN) data for 2006 to 2008 reported the overall SSI rate was 1.9% (16,147 SSIs following 849,659 operative procedures).3 The aim of antimicrobial prophylaxis is to prevent SSI by reducing the burden of microorganisms at the surgical site during the operative procedure,4 and ultimately to prevent related morbidity and mortality. Indications for antimicrobial prophylaxis, antibiotic selection, timing, and dosing are reviewed.

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Table 110–1AClassification of surgical site infection (SSI).1
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Surgical wound infections are historically classified into 4 groups based on the degree of expected microbial contamination during surgery (Table 110–1B).5 Antimicrobial treatment (vs prophylaxis) is required for dirty procedures or established infections. Antimicrobial prophylaxis is justified for contaminated or most clean-contaminated procedures and in certain clean procedures (eg, prosthetic implants).6 Also, antimicrobial prophylaxis may be justified for any procedure if the patient has an underlying medical condition associated with a high risk of SSI (Table 110–2).6

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Table 110–1BWound classification.5

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