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Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery.

Publication ,  Journal Article
Klifto, KM; Rydz, AC; Biswas, S; Hultman, CS; Erdmann, D; Phillips, BT
Published in: Plast Reconstr Surg
December 1, 2023

BACKGROUND: After nearly a decade of new data, the Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons was updated for prophylactic systemic antibiotics to prevent surgical-site infections (SSI). Pharmacotherapeutic concepts using antimicrobial stewardship were applied for clinical interpretation and management to optimize patient outcomes and minimize resistance. METHODS: PRISMA, Cochrane, and GRADE certainty of evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched for randomized controlled trials (RCTs). The authors included patients who had plastic and reconstructive surgery and were treated with prophylactic systemic antibiotics administered perioperatively (preoperatively, intraoperatively, or postoperatively). Comparisons were made between active interventions and nonactive interventions (placebo) at different prespecified durations to determine the development of an SSI. Meta-analyses were performed. RESULTS: The authors included 138 RCTs that met eligibility criteria. RCTs consisted of 18 breast, 10 cosmetic, 21 hand/peripheral nerve, 61 pediatric/craniofacial, and 41 reconstructive studies. The authors examined bacterial data extracted from studies for patients who did or did not take prophylactic systemic antibiotics for prevention of SSI. Clinical recommendations were provided using level I evidence. CONCLUSIONS: Surgeons have long been overprescribing systemic antibiotic prophylaxis in plastic and reconstructive surgery. Evidence supports antibiotic prophylaxis to prevent SSI for specific indications and durations. Prolonged antibiotic use has not been linked to reductions in SSIs, and misuse may increase the bacterial diversity of infections. Greater efforts should focus on transitioning from practice-based to pharmacotherapeutic evidence-based medicine. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

December 1, 2023

Volume

152

Issue

6

Start / End Page

1154e / 1182e

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery, Plastic
  • Surgery
  • Humans
  • Evidence-Based Medicine
  • Child
  • Antibiotic Prophylaxis
  • Anti-Bacterial Agents
  • 3203 Dentistry
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Klifto, K. M., Rydz, A. C., Biswas, S., Hultman, C. S., Erdmann, D., & Phillips, B. T. (2023). Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery. Plast Reconstr Surg, 152(6), 1154e-1182e. https://doi.org/10.1097/PRS.0000000000010608
Klifto, Kevin M., Alexandria C. Rydz, Sonali Biswas, C Scott Hultman, Detlev Erdmann, and Brett T. Phillips. “Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery.Plast Reconstr Surg 152, no. 6 (December 1, 2023): 1154e-1182e. https://doi.org/10.1097/PRS.0000000000010608.
Klifto KM, Rydz AC, Biswas S, Hultman CS, Erdmann D, Phillips BT. Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery. Plast Reconstr Surg. 2023 Dec 1;152(6):1154e-1182e.
Klifto, Kevin M., et al. “Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery.Plast Reconstr Surg, vol. 152, no. 6, Dec. 2023, pp. 1154e-1182e. Pubmed, doi:10.1097/PRS.0000000000010608.
Klifto KM, Rydz AC, Biswas S, Hultman CS, Erdmann D, Phillips BT. Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery. Plast Reconstr Surg. 2023 Dec 1;152(6):1154e-1182e.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

December 1, 2023

Volume

152

Issue

6

Start / End Page

1154e / 1182e

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery, Plastic
  • Surgery
  • Humans
  • Evidence-Based Medicine
  • Child
  • Antibiotic Prophylaxis
  • Anti-Bacterial Agents
  • 3203 Dentistry
  • 3202 Clinical sciences