| Popis: |
The administration of antimicrobial agents prophylactically during the perioperative period has become standard practice for surgical procedures involving the implantation of prosthetic material, and most authorities in the field of surgical wound prophylaxis have endorsed this practice. A recent meta-analysis of nine randomized, controlled studies involving 1,045 patients undergoing placement of ventricular shunts suggested that antimicrobial prophylaxis reduced infection risk twofold, but was of apparent benefit only if infection rates in the control group were greater than 5%. While clinical studies verifying that perioperative antibiotics significantly reduce implant infection rates are not available for the majority of such procedures, significant benefits frequently have been demonstrated when infections within any part of the surgical incision, not just the prosthetic device, are included in the evaluation. Although these differences did not achieve statistical significance because of the paucity of infections observed in either group, the authors advocated the three-dose regimen pending more definitive data. In prophylaxis of prosthetic valve endocarditis, however, anecdotal associations between episodes of transient bacteremia and endocarditis have led to an almost universal recommendation for aggressive antimicrobial prophylaxis for patients with prosthetic valves who undergo dental procedures and surgery. The choice of an antimicrobial regimen and the duration of use remain matters of great confusion. When recurrent pathogens are encountered, a systematic evaluation of new prophylactic regimens, possibly in the form of ongoing randomized trials, may provide a database for a rational approach to infection prevention in implantation surgery. |
