SHOULD ANTIBIOTIC-PROPHYLAXIS BE USED ROUTINELY IN CLEAN SURGICAL-PROCEDURES - A TENTATIVE YES

Background. The incidence of surgical site infection (SSI) after clean surgical procedure has traditionally been regarded as too low for rou tine antibiotic prophylaxis. But we now Know that host factors may inc rease the risk of SSI to as high as 20%. We assessed the value of prop hylactic cefotaxime in patients stratified for risk of SSI in a random ized double-blind trial Methods. Patients admitted for clean elective operations were enrolled, stratified for risk by National Nosocomial I nfection Survey criteria, and randomized to receive intravenous cefota xime 2 gm or placebo on call for operation. They were followed for 4 t o 6 weeks for SSI diagnosed by Centers for Disease Control and Prevent ion criteria. Results. Analysis of 775 patients showed that the 378 ev aluable patients who received cefotaxime had 70% fewer SSIs than those who did not-Mantel-Haenszel risk ratio (MH-RR) 0.31; 95% confidence i ntervals (CI) 0.11 to 0.83. Benefit was clear in the 616 low risk pati ents-0.97% versus 3.9% SSI (MK-RR 0.25, CI 0.07 to 0.87, p = 0.018), b ut only a trend was seen in 136 high risk patients-2.8% versus 6.1% SS I (MH-RR 0.48, CI 0.09 to 2.5). Conclusions. The results indicate clea r benefit for routine antibiotic prophylaxis in clean surgical procedu res. High risk patients need more study.