Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections: Results From the Trial to Reduce Antimicrobial Prophylaxis Errors A collaborative intervention to improve surgical antibiotic prophylaxis in children: results from a prospective multicenter study Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection. Implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and postintervention study. Successful implementation of a window for routine antimicrobial prophylaxis shorter than that of the World Health Organization standard. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial A Randomized, Double-blinded Placebo-controlled Clinical Trial of the Routine Use of Preoperative Antibiotic Prophylaxis in Modified Radical Mastectomy Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand Standardized incidence rates of surgical site infection: a multicenter study in Thailand. Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). A tale of 2 hospitals: a staggered cohort study of targeted interventions to improve compliance with antibiotic prophylaxis guidelines. A multicentre placebo-controlled randomised clinical trial of antibiotic prophylaxis for placement of single dental implants. Optimizing the timing of antimicrobial prophylaxis in surgery: an intervention study. Optimal timing of prophylactic antibiotic for cesarean delivery: a randomized comparative study. Prospective surveillance for surgical site infection in St. Petersburg, Russian Federation.
Objective : The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis ( AMP ) . Summary Background Data : National AMP guidelines should be supported by evidence from large contemporary data sets . Methods : Twenty-nine hospitals prospect ively obtained information on AMP from 4472 r and omly selected cardiac , hip/knee arthroplasty , and hysterectomy cases .  Surgical site infections ( SSIs ) were ascertained through routine surveillance , using National Nosocomial Infections Surveillance system methodology . The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression ( conditioning on hospital ) . Results : One-hundred thirteen SSI were detected in 109 patients .  SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased ( overall association between timing and infection risk P = 0.04 ) . When antibiotics requiring long infusion times ( vancomycin and fluoroquinolones ) were excluded , the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6 % compared with 2.4 % associated with administration of antibiotic between 31 to 60 minutes prior to surgery ( OR : 1.74 ; 95 % confidence interval , 0.98–3.04 ) . The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision . Intraoperative redosing ( performed in only 21 % of long operations ) appeared to reduce SSI risk in operations lasting more than 4 hours ( OR of 3.08 with no redosing ; 95 % confidence interval 0.74–12.90 ) , but only when the preoperative dose was given correctly . Conclusions : These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision Purpose The use of surgical antibiotic prophylaxis ( SAP ) in children is poorly characterized . Our aim was to evaluate the effectiveness of a quality improvement ( QI ) intervention targeting  SAP in children , by means of a multicenter prospect i ve intervention study , with a before and after design . Methods We prospect ively investigated elective surgical procedures performed in children < 18 years , prior to the QI intervention  , after the intervention and at 9-month follow-up . The primary outcomes were adherence to SAP indications and SAP appropriateness , defined considering antibiotic choice , timing of first dose and duration of administration . We compared SAP adherence and appropriateness prior the QI intervention , to the post-intervention and the follow-up . We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness . Results We collected information on 2383 procedures ( pre-intervention : 784 ; post-intervention : 790 ; follow-up : 809 ) . The QI intervention had a significant impact on the adherence to SAP indications ( 86.6 % in the post-intervention , compared to 82.0 % prior to the intervention ; p < 0.05 ) , and on its appropriateness ( 35.7 % compared to 19.9 % ; p < 0.01 ) . The impact of the intervention on SAP appropriateness was maintained at follow-up ( 38.3 % ; p < 0.01 compared to pre-intervention ) . All components of SAP appropriateness significantly improved after the intervention and at follow-up . The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness . Conclusions Following the QI intervention , there was a significant improvement in quality of SAP in pediatric surgery , though more efforts are needed to increase SAP appropriateness OBJECTIVE To compare the rate of surgical site infection ( SSI )  before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented . To demonstrate that a more prudent , restrictive policy would not have a detrimental effect on patient outcomes . DESIGN Before-after trial with prospect i ve SSI surveillance in the Dutch nosocomial surveillance network ( Preventie Ziekenhuisinfecties door Surveillance [ PREZIES ] ) , using the criteria of the Centers for Disease Control , including postdischarge surveillance for up to 1 year . METHODS During a preintervention period and a postintervention period ( both 6 - 13 months ) , 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates . The study was limited to commonly performed surgical procedures in 4 specialties : vascular , intestinal , gynecological and orthopedic surgery . Selected risk factors for analysis were sex , age , American Society of Anesthesiologists classification , wound contamination class , duration of surgery , length of hospital stay before surgery , and urgency of surgery ( elective or acute ) . RESULTS A total of 3,621 procedures were included in the study , of which 1,668 were performed before the intervention and 1,953 after . The overall SSI rate decreased from 5.4 % to 4.5 % ( P=.22 ) . Among the procedures included in the study , the largest proportion ( 55 % ) were total hip arthroplasty , and the smallest proportion ( 2 % ) were replacement of the head of the femur . SSI rates varied from 0 % for vaginal hysterectomy to 21.1 % for femoropopliteal or femorotibial bypass surgery . Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention ( P>.1 ) . CONCLUSIONS An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery , as measured by SSI rate BACKGROUND Although evidence -based guidelines for best practice s pertaining to surgical site infection ( SSI ) prophylaxis exist , the feasibility of implementing such practice s remains to be demonstrated outside of a controlled clinical trial . This study was design ed to assess the safety and feasibility of implementing evidence -based care practice s to prevent SSIs . STUDY DESIGN A prospect i ve , double-cohort ( pre- and postintervention ) trial in elective , general surgery patients was conducted . All patients undergoing elective , major colorectal or hepatobiliary operations were enrolled . Postintervention cohort patients were exposed to new strategies to improve antibiotic administration times , perioperative normothermia rates , and  perioperative glucose control .  They were compared with the preintervention cohort , which received st and ard practice at the time . Outcomes evaluated include timing of antibiotic administration , perioperative temperatures , and postoperative glucose levels . SSI rates between cohorts were also compared . RESULTS A total of 208 patients were enrolled . The proportion of patients receiving their preoperative antibiotics within 60 minutes improved from 5.9 % to 92.6 % ( p < 0.001 ) ; perioperative normothermia rates improved from 60.5 % to 97.6 % ( p < 0.001 ) between cohorts . There was no improvement in rates of hyperglycemia . SSI rates improved but did not reach statistical significance ( 14.3 % versus 8.7 % ; p = 0.21 ) . CONCLUSIONS Implementation of evidence -based care practice s to prevent SSI is both safe and practical outside the setting of a r and omized , controlled trial . Sustained compliance remains to be demonstrated , although practice audits at our institution suggest ongoing success is possible OBJECTIVE To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis ( RAP ) of 30 - 74 minutes before skin incision compared to the World Health Organization ( WHO ) st and ard of 0 - 60 minutes . DESIGN Prospect i ve study on timing of routine antimicrobial prophylaxis in 2 different time periods . SETTING Tertiary referral university hospital with 30,000 surgical procedures per year . METHODS In all consecutive vascular , visceral , and trauma procedures , the timing was prospect ively recorded during a first time period of 2 years ( A ; baseline ) and a second period of 1 year ( B ; after intervention ) . An intensive intervention program was initiated after baseline . The primary outcome parameter was timing ; the secondary outcome parameter was surgical site infection ( SSI ) rate in the subgroup of patients undergoing cholecystectomy/colon resection . RESULTS During baseline time period A ( 3,836 procedures ) , RAP was administered 30 - 74 minutes before skin incision in 1,750 ( 41.0 % ) procedures ; during time period B ( 1,537 procedures ) , it was administered in 914 ( 56.0 % ; [ Formula : see text ] ) . The subgroup analysis did not reveal a significant difference in SSI rate . CONCLUSIONS This bundle of interventions result ed in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO st and ard Background Surgical site infections are the most common hospital-acquired infections among surgical patients . The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate . While most studies suggest that it should be given as close to the incision time as possible , others conclude that this may be too late for optimal prevention of surgical site infections . A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery . The aim of this article is to report the design and protocol of a r and omized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis . Methods / Design In this bi-center r and omized controlled trial conducted at two tertiary referral centers in Switzerl and , we plan to include 5,000 patients undergoing general , oncologic , vascular and orthopedic trauma procedures . Patients are r and omized in a 1:1 ratio into two groups : one receiving surgical antimicrobial prophylaxis in the anesthesia room ( 75 to 30 minutes before incision ) and the other receiving surgical antimicrobial prophylaxis in the operating room ( less than 30 minutes before incision ) . We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision . The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period ( one year with an implant in place ) . When assuming a 5 % surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room , the planned sample size has an 80 % power to detect a relative risk reduction for surgical site infections of 33 % when administering surgical antimicrobial prophylaxis in the anesthesia room ( with a two-sided type I error of 5 % ) . We expect the study to be completed within three years . Discussion The results of this r and omized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital . Moreover , the results of this r and omized controlled trial are of significant interest for patient safety and healthcare economics . Trial registration This trial is registered on Clinical Trials.gov under the identifier NCT01790529 Background The effectiveness of antibiotic prophylaxis for prevention of surgical site infection ( SSI ) following specific types of breast cancer surgery remains uncertain . This study assessed the effectiveness of prophylaxis in modified radical mastectomy  ( MRM ) . Methods Women undergoing MRM for breast cancer were recruited . Women were excluded who had diabetes mellitus , severe malnutrition or known allergy to cephalosporins ; were receiving corticosteroid therapy or were treated with antibiotics within one week prior to surgery ; were scheduled for simultaneous breast reconstruction or bilateral oophorectomy ; had existing local infection . Participants were r and omized to receive either intravenous cefazolin 1 g or placebo within 30 min prior to skin incision . St and ard skin preparation and operative technique for MRM were carried out . Wounds were assessed for SSI and other complications weekly for 30 days . Results A total of 254 women were recruited . Age , clinical stage , prior chemotherapy , and operative time were similar for antibiotic and placebo groups . The overall incidence of SSI was 14.2 % . There were no significant differences in the infection rate over the 30-day follow-up period between the placebo and antibiotic groups ( 15 % vs 13.4 % ; p = 0.719 ) or at each week . The majority of SSI were either cellulitis or superficial infection for both groups . There were no significant differences between groups in treatments required for SSI , incidence of hematoma or seroma . Conclusions The findings of this study , alone and when meta-analyzed with data from studies in similar surgical population s , do not support the use of antibiotic prophylaxis in MRM BACKGROUND Despite evidence supporting short antibiotic prophylaxis ( ABP ) , it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft ( CABG ) surgery . METHODS AND RESULTS To compare the effect of short ( < 48 hours ) versus prolonged ( > 48 hours ) ABP on surgical site infections ( SSIs ) and acquired antimicrobial resistance , we conducted an observational 4-year cohort study at a tertiary-care center . An experienced infection control nurse performed prospect i ve surveillance of 2641 patients undergoing CABG surgery . The main exposure was the duration of  ABP  , and main outcomes were the adjusted rate of SSI and the isolation of cephalosporin-resistant enterobacteriaceae and vancomycin-resistant enterococci ( acquired antibiotic resistance ) . Adjustment for confounding was performed by multivariable modeling . A total of 231 SSIs ( 8.7 % ) occurred after a median of 16 days , including 93 chest-wound infections ( 3.5 % ) and 13 deep-organ-space infections ( 0 . 5 % ) . After 1502 procedures using short ABP , 131 SSIs were recorded , compared with 100 SSIs after 1139 operations with prolonged ABP ( crude OR , 1.0 ; CI , 0.8 to 1.3 ) . After adjustment for possible confounding , prolonged ABP was not associated with a decreased risk of SSI ( adjusted OR , 1.2 ; CI , 0.8 to 1.6 ) and was correlated with an increased risk of acquired antibiotic resistance ( adjusted OR , 1.6 ; CI , 1.1 to 2.6 ) . CONCLUSIONS Our findings confirm that continuing ABP beyond 48 hours after CABG surgery is still widespread ; however , this practice is ineffective in reducing SSI , increases antimicrobial resistance , and should therefore be avoided Background No data currently exist about use of antibiotics to prevent surgical site infections ( SSI )  among patients undergoing appendectomy in Thail and . We therefore examined risk factors , use , and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy . Methods From July 1 , 2003 to June 30 , 2004 we conducted a prospect i ve cohort study in eight hospitals in Thail and . We used the National Nosocomial Infection Surveillance ( NNIS ) system criteria to identify SSI associated with appendectomy . We used logistic regression analysis to obtain relative risk estimates for predictors of SSI . Results Among 2139 appendectomy patients , we identified 26 SSIs , yielding a SSI rate of 1.2 infections/100 operations . Ninety-two percent of all patients ( 95 % CI , 91.0–93.3 ) received antibiotic prophylaxis . Metronidazole and gentamicin were the two most common antibiotic agents , with a combined single dose administered in 39 % of cases . In 54 % of cases , antibiotic prophylaxis was administered for one day . We found that a prolonged duration of operation was significantly associated with an increased SSI risk . Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively . Compared with no antibiotic prophylaxis , SSI relative risks for combined single-dose of metronidazole and gentamicin , one-day prophylaxis , and multiple-day antibiotic prophylaxis were 0.28 ( 0.09–0.90 ) , 0.30 ( 0.11–0.88 ) and 0.32 ( 0.10–0.98 ) , respectively . ConclusionS ingle-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing from SSI at the national level could not be assessed . The purpose of this study was to estimate the incidence of SSI in 9 hospitals , together with patterns of surgical antibiotic prophylaxis , risk factors for SSI , and common causative pathogens . METHODS A prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and was conducted . The National Nosocomial Infection Surveillance ( NNIS ) system criteria and method were used for identifying and diagnosing SSI . The SSI rates were benchmarked with the NNIS report by means of indirect st and ardization and reported in terms of st and ardized infection ratio ( SIR ) . Antibiotic prophylaxis was categorized into preoperative , intraoperative , and postoperative . Risk factors for SSI were evaluated using multiple logistic regression models . RESULTS From July 1 , 2003 , to February 29 , 2004 , the study included 8764 patients with 8854 major operations and identified 127 SSIs , yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 ( 95 % CI : 0.5 - 0.8 ) . Of these , 35 SSIs ( 27.6 % ) were detected postdischarge . The 3 most common operative procedures were cesarean section , appendectomy , and hysterectomy . The 3 most common pathogens isolated were Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa , which accounted for 15.3 % , 8.5 % , and 6.8 % of infections , respectively . The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin , cefazolin , and gentamicin . The proportion of types of antibiotic prophylaxis administered were 51.6 % preoperative , 24.3 % intraoperative , and 24.1 % postoperative . Factors significantly associated with SSI were high degree of wound contamination , prolonged preoperative hospital stay , emergency operation , and prolonged duration of operation . CONCLUSION Overall SSI rates were less than the average NNIS rates . The causative pathogens of SSI were different from those of other reports . There was a crucial proportion of operations that did not comply with the antibiotic guidelines . The risk factors for SSI identified in this study were consistent with most other reports BACKGROUND Surgical site infections ( SSIs ) following total hip arthroplasty can lead to prolonged hospitalization , increased morbidity and mortality , and high costs . This article analyzes the effect of various parameters of surgical antibiotic prophylaxis on the risk of SSI following total hip arthroplasty . METHODS Data about SSI and potential prophylaxis- , patient- , and procedure-related risk factors were prospect ively collected for 1922 patients who underwent elective total hip arthroplasty in 11 hospitals that participated in the Dutch intervention project , Surgical Prophylaxis and Surveillance .  Multivariate logistic regression analysis was performed to correct for r and om variation among hospitals . RESULTS SSIs ( superficial and deep ) occurred in 50 patients ( 2.6 % ) . The highest odds ratios for SSI were found in patients who received prophylaxis after incision ( 2.8 , 95 % confidence interval [ CI ] , 0.9 - 8.6 ; P=.07 ) , had an American Society of Anesthesiology score that was > 2 ( 2.8 , 95 % CI , 0.8 - 9.2 ; P=.09 ) , and experienced a duration of surgery that was > 75th percentile ( 2.5 ; 95 % CI , 1.1 - 5.8 ; P=.04 ) . Prolonged prophylaxis after the end of surgery and the use of antibiotic-impregnated cement did not contribute to fewer SSIs in this study . CONCLUSIONS This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis OBJECTIVE To evaluate the risk factors for surgical site infection ( SSI ) after gastric surgery in patients in Korea . DESIGN A nationwide prospect i ve multicenter study . SETTING Twenty university-affiliated hospitals in Korea . METHODS The Korean Nosocomial Infections Surveillance System ( KONIS ) , a Web-based system , was developed . Patients in 20 Korean hospitals from 2007 to 2009 were prospect ively monitored for SSI for up to 30 days after gastric surgery .  Demographic data , hospital characteristics , and potential perioperative risk factors were collected and analyzed , using multivariate logistic regression models . RESULTS Of the 4,238 case patients monitored , 64.9 % ( 2,752 ) were male , and mean age ( ± SD ) was 58.8 ( ± 12.3 ) years .  The SSI rates were 2.92 , 6.45 , and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0 , 1 , and 2 or 3 , respectively . The majority ( 69.4 % ) of the SSIs observed were organ or space SSIs . The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae . Male sex ( odds ratio [ OR ] , 1.67 [ 95 % confidence interval ( CI ) , 1.09 - 2.58 ] ) , increased operation time ( 1.20 [ 1.07 - 1.34 ] per 1-hour increase ) , reoperation ( 7.27 [ 3.68 - 14.38 ] ) , combined multiple procedures ( 1.79 [ 1.13 - 2.83 ] ) , prophylactic administration of the first antibiotic dose after skin incision ( 3.00 [ 1.09 - 8.23 ] ) , and prolonged duration ( ≥7 days ) of surgical antibiotic prophylaxis ( SAP ; 2.70 [ 1.26 - 5.64 ] ) were independently associated with increased risk of SSI . CONCLUSIONS Male sex , inappropriate SAP , and operation-related variables are independent risk factors for SSI after gastric surgery BACKGROUND The purpose of this prospect i ve study was to determine the effectiveness of targeted interventions to improve compliance with  antibiotic prophylaxis guidelines ( timing , spectrum , and discontinuation ) at 2 university-affiliated hospitals . METHODS Based on barriers identified previously , hospital-specific interventions were developed such as educational conferences , st and ardized forms , an extended time-out , and feedback . Guideline compliance and surgical site infection ( SSI ) data were recorded on all patients who underwent elective laparotomies for colorectal procedures , vascular operations , and hysterectomies during four 6-month study periods . Pre study data from July to December 2006 served as a baseline . One year later , a prospect i ve cohort study was performed . The interventions were introduced to the 2 hospitals in a staggered fashion with 2-month implementation periods before reassessing compliance during the 6-month study periods . General linear modeling was performed ( P < .05 significant ) . RESULTS Compliance with all 3 guidelines combined improved during the year preceding the study , after attention only , at both hospitals . Hospital-specific differences were found in the effectiveness of the intervention package on individual guidelines . Hospital 2 but not 1 improved in timing after the interventions ; both hospitals improved in spectrum , and neither hospital improved in discontinuation . Overall compliance with all 3 antibiotic prophylactic measures was greater at hospital 1 , but hospital 2 had lower SSI rates . CONCLUSION Simply increasing attention to a quality problem can result in a significant and sustained improvement . Quality improvement interventions should be evaluated rigorously for effectiveness given hospital-specific differences in effectiveness and for correlation of guideline compliance with outcome PURPOSE To compare the efficacy and safety of 2 g amoxicillin orally with identical placebo tablets 1 hour before implant placement when placing single implants in bone types II and III . MATERIAL AND METHODS 12 private dental clinics in Spain agreed to participate in this trial . A total of 105 patients were recruited . Patients were r and omised for consumption orally of 2 g amoxicillin or identical placebo tablets .  Only patients needing single implants were included . Outcome measures were post-operative infections , adverse events and implant failures . Characteristics of the saprophytic flora were also studied in all patients . Patients were seen 3 days , 10 days , 1 month and 3 months postoperatively . RESULTS A total of 105 patients ( n = 52 in the amoxicillin group and n = 53 in the placebo group ) were evaluated and none were excluded from the study at 3 months . Six post-operative infections occurred and two implants were lost in each group . There were no statistically significant differences for postoperative infection , adverse events , implant failures and the characteristics of saprophytic flora between groups . The use of amoxicillin did not either alter or modify the characteristics of the saprophytic flora nor provoke remarkable side effects . CONCLUSIONS Antibiotic prophylaxis may not be needed when placing single implants in patients with bone types II and III The timing of surgical antimicrobial prophylaxis  was determined before and after an intervention programme of education of surgeons , anaesthetists and nurses on the subject of antimicrobial drug prophylaxis , and the subsequent implementation of new protocol s of single dose prophylaxis administered within one hour before incision . This prospect i ve study was performed in three surgical departments of a university hospital . For comparison , the timing of prophylaxis was also determined in an operating department of a community hospital . The timing improved considerably in the departments of the university hospital where the intervention was carried out : administration of the first dose within one hour before incision increased from 39 % to 69 % in department A and from 64 % to 80 % in department B. Before the intervention , seven out of 16 prophylactic doses were given after inflation of the tourniquet . After the intervention all doses of prophylactic antibiotics were administered before inflation of the tourniquet . Initially , the intervals of multidose prophylaxis varied widely . In the second review , single-dose prophylaxis increased from 21 % to 78 % in department A and from 31 % to 85 % in department B. We conclude that the intervention succeeded in improving the quality of surgical prophylaxis AIM Cesarean delivery is associated with a significantly higher postoperative infection rate than that following vaginal birth and other surgical procedures . This study compared whether antibiotic prophylaxis administered preoperatively was more effective in preventing infectious morbidity following cesarean delivery than administration at cord clamping . MATERIAL AND METHODS In a r and omized comparative trial , 953 women with a period of gestation of more than 34 weeks , scheduled to have cesarean section , were r and omly assigned to the prophylactic single-dose antibiotic administration either preoperatively ( study group ) or at cord clamping ( control group ) . Primary outcome measure was postoperative maternal infectious morbidity and secondary outcome measures were neonatal complications , and postoperative maternal hospital stay and stay of neonates in the neonatal intensive care unit . RESULTS Wound complications in the form of in duration s , erythema and discharge , were significantly fewer in the study group as compared to the control group ( 10/476 vs 25/477 , P = 0.010 , conditional maximum likelihood estimate of odds ratio = 0.388 and 95 % confidence interval = 0.175 - 0.805 ) . Women in the study group also had fewer incidents of endomyometritis when compared to the control group ( 1.47 % vs 3.56 % ; P = 0.041 ; conditional maximum likelihood estimate of odds ratio = 0.404 ) . There was no significant difference in neonatal outcomes between the two groups . Mean postoperative stay of mothers in hospital was significantly shorter in the study group ( P = 0.009 , 95 % confidence interval = -0.368 to -0.052 ) but neonatal intensive care unit stay of neonates was similar in both groups . CONCLUSION Administration of prophylactic antibiotic at 30 - 60 min before skin incision result ed in better maternal outcome when infectious morbidity and postoperative hospital stay were concerned , without influencing the neonatal outcome OBJECTIVE To assess the risk-adjusted incidence and predictors of  surgical site infections ( SSIs ) .  DESIGN Prospect i ve , multicenter , observational cohort study . SETTING Seven surgical departments at 3 urban academic hospitals in St. Petersburg , Russian Federation . PATIENTS All patients had surgery performed between January 15 and May 12 , 2000 . A total of 1,453 surgical procedures were followed up . Medical records were unavailable for less than 3 % of all patients ; patients were not excluded for any other reason . The mean patient age was 49.3 years , 61 % were female , and 34 % had an American Society of Anesthesiologists physical status classification ( hereafter , " ASA classification " ) of at least 3 . Surgery for 45 % of the patients was emergent . RESULTS In all , 138 patients ( 9.5 % ) developed SSI , for a rate that was approximately 3.5 times the risk-stratified rates in the United States . Male sex ( odds ratio [ OR ] , 1.54 ) , ASA classifications of 3 ( OR , 3.7 ) or 4 ( OR , 5.0 ) , longer duration of surgery ( OR , 2.2 ) , and wound classes of 3 ( OR , 5.5 ) or 4 ( OR , 14.3 ) were associated with increased SSI risk in multivariate analysis . Endoscopic surgery was associated with a lower risk of SSI ( OR , 0.23 ) .  Antibiotic prophylaxis  was used in 0%-33 % of operations , and 69 % of uninfected patients received antibiotics after the operation . CONCLUSIONS The SSI rates are significantly higher than previously reported . Although this finding may be attributable to inadequate antibiotic prophylaxis , local infection control and surgical practice s may also be contributors . Use of antibiotic prophylaxis should be encouraged and the effect of local practice s further investigated . Active SSI surveillance should be exp and ed to other parts of the Russian Federation
Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision .
Abstract The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis ( SAP ) on  surgical site infection ( SSI )  and compare the different timing intervals .
The benefit of routine use of SAP prior to surgery has long been recognized .
However , the optimal timing has not been defined .