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LETTER TO EDITOR
J Res Med Sci 2019,  24:90

Responding to the Global Guidelines for the Prevention of Surgical Site Infection, 2018: A focus on surgical antibiotic prophylaxis prolongation


1 Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Department of Clinical Division, Central Leprosy Teaching and Research Institute, Chengalpattu, Tamil Nadu, India

Date of Web Publication25-Oct-2019

Correspondence Address:
Pugazhenthan Thangaraju
Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrms.JRMS_21_19

Clinical trial registration IRCT2016051827965N1

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How to cite this article:
Thangaraju P, Venkatesan S. Responding to the Global Guidelines for the Prevention of Surgical Site Infection, 2018: A focus on surgical antibiotic prophylaxis prolongation. J Res Med Sci 2019;24:90

How to cite this URL:
Thangaraju P, Venkatesan S. Responding to the Global Guidelines for the Prevention of Surgical Site Infection, 2018: A focus on surgical antibiotic prophylaxis prolongation. J Res Med Sci [serial online] 2019 [cited 2019 Nov 22];24:90. Available from: http://www.jmsjournal.net/text.asp?2019/24/1/90/269896



Sir,

Recently, the Global Guidelines for the Prevention of Surgical Site Infection (SSI) has been updated and released. There are no differences between the first edition (2016)[1] of the guideline and the second edition (2018),[2] pertaining to the antibiotic prophylaxis timing, selection, and the continuation beyond the requirement. As both guidelines, the WHO recommends against the prolongation of surgical antibiotic prophylaxis administration for preventing the SSI after completion of any type of operation. As per the antimicrobial resistance (AMR) guideline 2016 of India, it was emphasized only on single-dose antibiotic prophylaxis preoperatively.[3] A review also commented on single-dose administration and also on the appropriate timing of the administration of antibiotic.[4] The two guidelines were designed and recommended safely keeping in mind regarding the AMR that is prevalent globally. This updated guideline will definitely guide countries like India to draft or retain the current guidelines as per the local needs, drug policies, and status of implementation of the antibiotic stewardship in their respective countries. The guideline also emphasized on the awareness to the staff involved or handling as it is also going to be the main component in resistance, thereby helping in the prevention of SSI.

The health professionals dealing with antibiotic prophylaxis in the surgery should be more focused on the antibiotic selection and the optimal timing it has to be administered. Since the guideline goes against the usage of antibiotic after 24 h of completion of surgery, this should be followed in strict so that unnecessary burden to the patient is reduced in aspect of resistance development for him/her or cross-resistance with the other needy patients.


  Summary of Antimicrobial Resistance Guideline of India as Surgical Prophylaxis Versus Global Updated Guideline Top


The antibiotic should be administered within 60 min before the surgical incision as compared to the WHO Global Guideline of 120 min. Both the local and the WHO emphasize on single dose. The second intraoperative dose is planned in prolong surgery based on the choice of antibiotic used for prophylaxis based on the half-life of the drugs. Both guideline and AMR stress on the prophylaxis of the antibiotic should not be given beyond surgery duration, with few exceptions for cardiothoracic surgery up to 48 h permissible in the Indian scenario as compared to >24 h as mentioned in the global guideline for cardiac orthognathic and vascular surgery.[2],[3] Choice of the prophylaxis should be based on the local antibiogram as emphasized in general. The common antibiotics used as prophylaxis are cefazolin, cefuroxime, ceftriaxone, cefoperazone sulbactam, piperacillin, and tazobactam in the Indian scenario based on the type of surgery.

In conclusion, the guideline should be focused and be read vigilantly in developing countries to prevent death due to SSI and the development of microbial resistance.

Acknowledgments

We would like to acknowledge the Global Guideline on Prevention of Surgical Site Infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Global Guidelines for the Prevention of Surgical Site Infection; 2016. Available from: http://apps.who.int/iris/bitstream/handle/10665/250680/9789241549882-eng.pdf?sequence=8. [Last retrieved on 2019 Jan 10].  Back to cited text no. 1
    
2.
World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. 2nd ed. Geneva: World Health Organization; 2018.  Back to cited text no. 2
    
3.
National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. Available from: http://www.pbhealth.gov.in/AMR_guideline7001495889.pdf. [Last retrieved on 2019 Jan 10].  Back to cited text no. 3
    
4.
Singh H, Arora E, Thangaraju P, Singh J, Natt NK. Antimicrobial resistance: New patterns, emerging concepts and prevention. J Ration Pharmacother Res 2013;1:95-9.  Back to cited text no. 4
    




 

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