Prolonged duration of antimicrobial agents is also associate

Prolonged duration of antimicrobial agents is also associated with increased risk of CDI by extending the time disruption of normal enteric flora. This emphasizes the importance for clinicians to adhere to shorter durations of therapy. Although longer durations of therapy are associated with a greater risk of CDI, it Hydroxyurea receptor is important to remember that even single doses of antimicrobials used for surgical prophylaxis have been established as risks for CDI.12, 13 Guidelines for appropriate use of antimicrobial surgical prophylaxis have been published jointly by the Infectious Diseases Society of America, Surgical Infection Society, American Society of Health-System Pharmacists, and the Society for Healthcare Epidemiology of America, which recommends limiting the duration of antimicrobials to reduce adverse effects such as CDI and emergence of resistance. The duration of antimicrobial prophylaxis for most procedures should not exceed 24 hours. There may, however, be procedure-specific exceptions. Extended antibiotic prophylaxis has been associated with significantly increased C difficile risk. More recently the World Health Organization has issued Global Guidelines for the prevention of surgical site infection in addition to the 2017 Centers for Diseases Control and Prevention Guideline for the Prevention of Surgical Site Infection.16, 17 Both guidelines recommend for clean-contaminated procedures no further prophylaxis be administered after the surgical incision is closed, even in the presence of a drain.
Risk of developing antibiotic resistance The discovery of potent antimicrobial agents was one of the greatest contributions to medicine in the 20th century. When introduced, they had an immediate and dramatic effect as some infections that were previously universally fatal (e.g., bacterial meningitis) were readily curable. Unfortunately, the emergence of antimicrobial-resistant pathogens now threatens these advances. Antimicrobial resistance is a serious health threat that affects the clinical outcome of patients as well as results in higher rates of adverse events and health care costs. The seriousness of the health impact of antimicrobial resistance is a major public health crisis. Unfortunately, there are already patients every day who contract infections who cannot be treated with currently available antimicrobials. Although principles of appropriate use have been encouraged since the introduction of antimicrobials, abiding by them is now more urgent than ever. The CDC estimates that approximately half of SSIs are deemed preventable if surgeons used evidence-based strategies. Surgeons must be aware that judicious antibiotic utilization is necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. There is no question that antibiotic use is the most important modifiable factor in tackling the problem of antibiotic resistance. Strategies to reduce antibiotic resistance should be instituted by all health care professionals. Unfortunately much of antimicrobial use within the hospital setting is for cases that do not warrant such therapy. Resistant organisms often occur as the consequence of treatment that has been incorrectly dosed, and/or given for an inappropriate duration (usually too long). It is vitally important that the judicious use of antimicrobial be encouraged in order to curb this overuse, and hopefully, minimize resistance emergence. The Executive Council of the Surgical Infections Society issued a call to action for surgeons around the world to actively participate in a global fight against antibiotic resistance and demonstrate awareness of antibiotic resistance. One way to promote the appropriate use of antimicrobials is through the development and application of treatment guidelines. Evidence-based guidelines provide guidance for appropriate drug, dose, and duration. Over the past decade there has been increased evidence of the effectiveness of shorter course antimicrobial therapy and this has been incorporated into recommendations in recent guidelines.19, 20, 21, 22 The ultimate goals of short-course antimicrobial therapy are to rapidly eradicate pathogenic microorganisms and reduce selective pressure for emergence of resistance. The primary potential advantages of shorter duration antimicrobial therapy include less toxicity, better adherence, reduced disruption of endogenous flora and risk of “superinfections,” such as C. difficile-associated disease, as well as reduction of emergence of antimicrobial resistance and lower cost. Effective short-course antimicrobial therapy also appears to better meet patient expectations of therapy than longer courses. Guidelines from the Surgical Infection Society and Infectious Diseases Society of America state that antimicrobial therapy of established or complicated intra-abdominal infection in adults “should be limited to 4–7 days, unless it is difficult to achieve adequate source control.” The safety and efficacy of shorter course therapy for surgical infections has been demonstrated in a recent prospective trial by Sawyer et al. In patients with complicated intra-abdominal infections who underwent an adequate source-control procedure, the outcomes after approximately 4-day fixed-duration antibiotic therapy were similar to those after a longer course of antibiotic agents that were administered for 8–10 days. Studies also indicate there is a very low risk of infection recurrence or treatment failure when antimicrobial therapy is terminated in a patient diagnosed with a complicated intra-abdominal infection who no longer shows signs of continuing infection.24, 25