Preoperative antibiotic prophylaxis: the role of the anesthesiologist.

Abstract

To the Editor:—Antibiotics given for prophylaxis of surgical site infections are known to be significantly more effective when administered immediately before surgical incision. 1Many institutions, therefore, expect the anesthesiologist to assume the responsibility for antibiotic administration. 2,3However, anesthesiologists receive little, if any, training in antibiotic therapy during residency or through continuing medical education. 3Pressure from our institutional infection control group to take responsibility for antibiotic administration led to much debate in our department as to what role we were willing to assume. Although most of us were comfortable with the actual administration of the antibiotic, we did not feel qualified to make the antibiotic selection. Furthermore, we have found that although most of our surgeons have considerably more knowledge about antibiotic prophylaxis than we do, many lack confidence in drug selection, particularly in complex cases. Although several articles have advocated the training of anesthesiologists in antibiotic administration, 2,3to our knowledge the issue of who should select the drug has not been addressed in the literature.After much discussion, a compromise was reached whereby the infection control committee at our institution provides a protocol for antibiotic administration for the prophylaxis of surgical site infections. This protocol specifies antibiotic choice and dose by procedure, including specific patient considerations. It also includes alternatives in the event of allergy to the first-line drug. The protocol is condensed onto laminated cards, which are attached to our anesthesia machines. The infection control committee is responsible for intermittently updating the antibiotic protocol based on new developments in antibiotic therapy and evolutions in local epidemiology. We have not attached our current protocol because of the rapid evolution of antibiotic therapy and regional differences in epidemiology, but we would happy to share our current protocol on request.The antibiotic protocol for surgical prophylaxis provides both anesthesiologists and surgeons with the comfort that we are giving our patients the optimal antibiotic regimen. Appropriate administration of the recommended antibiotic is a responsibility we are willing to assume to ensure timely administration of the drugs and to do our part to reduce surgical site infections.