Surgical and procedural antibiotic prophylaxis in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

Michael Steven Farrell; John Varujan Agapian; Rachel D Appelbaum; Dina M Filiberto; Rondi Gelbard; Jason Hoth; Randeep Jawa; Jordan Kirsch; Matthew E Kutcher; Eden Nohra; Abhijit Pathak; Jasmeet Paul; Bryce Robinson; Joseph Cuschieri; Deborah M Stein

doi:10.1136/tsaco-2023-001305

Surgical and procedural antibiotic prophylaxis in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

Trauma Surg Acute Care Open. 2024 Jun 3;9(1):e001305. doi: 10.1136/tsaco-2023-001305. eCollection 2024.

Authors

Affiliations

¹ Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
² Surgery, University of California Riverside, Rancho Cucamonga, California, USA.
³ Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁵ Department of Surgery, University of Alabama at Birmingham Center for Health Promotion, Birmingham, Alabama, USA.
⁶ Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁷ Stony Brook University, Stony Brook, New York, USA.
⁸ Westchester Medical Center, Valhalla, New York, USA.
⁹ Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹⁰ University of Colorado Boulder, Boulder, Colorado, USA.
¹¹ Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
¹² University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
¹³ Surgery, Harborview Medical Center, Seattle, Washington, USA.
¹⁴ Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA.
¹⁵ University of Maryland Baltimore, Baltimore, Maryland, USA.

Abstract

The use of prophylactic measures, including perioperative antibiotics, for the prevention of surgical site infections is a standard of care across surgical specialties. Unfortunately, the routine guidelines used for routine procedures do not always account for many of the factors encountered with urgent/emergent operations and critically ill or high-risk patients. This clinical consensus document created by the American Association for the Surgery of Trauma Critical Care Committee is one of a three-part series and reviews surgical and procedural antibiotic prophylaxis in the surgical intensive care unit. The purpose of this clinical consensus document is to provide practical recommendations, based on expert opinion, to assist intensive care providers with decision-making for surgical prophylaxis. We specifically evaluate the current state of periprocedural antibiotic management of external ventricular drains, orthopedic operations (closed and open fractures, silver dressings, local, antimicrobial adjuncts, spine surgery, subfascial drains), abdominal operations (bowel injury and open abdomen), and bedside procedures (thoracostomy tube, gastrostomy tube, tracheostomy).

Keywords: antibiotic prophylaxis; infections.