Systematic review and evidence-based guidance on peri-operative antibiotic prophylaxis

Systematic review Technical report

​Peri-operative antibiotic prophylaxis (PAP) has been shown to be an effective measure for preventing surgical site infections. However, its use contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increases in antibiotic resistance and healthcare costs. This literature review was therefore commissioned to explore the effectiveness of key modalities of peri-operative antibiotic prophylaxis and to develop five key PAP modalities and process indicators for monitoring their implementation on the basis of scientific evidence and expert opinion.

Executive summary

​Peri-operative antibiotic prophylaxis (PAP) is considered one of the most effective measures for the prevention of surgical site infections (SSIs). An ECDC commissioned ‘Systematic review and evidence-based guidance on peri-operative antibiotic prophylaxis’ was performed to identify effective measures to improve compliance with PAP among healthcare professionals. The evidence-based conclusions of this systematic review were further evaluated and ranked by an expert group, thus producing five “key modalities”. The ranking was performed taking into account the evidence with respect to effectiveness, implementability and EU-wide applicability.  The five key modalities presented in this ECDC guidance are the five most effective measures shown to improve the compliance of healthcare professionals with appropriate administration, timing, dosage and duration of PAP for the prevention of SSIs.  Indicators were also developed as part of the process, for the monitoring of the five key modalities. These include, among others, compliance with the indication, selection, timing, dosage and duration of PAP, the frequency of administration of PAP by an anesthesiologist or another designated professional when PAP is indicated and the presence and frequency of meetings of a multidisciplinary team. These key modalities and indicators can be adopted or adapted by hospitals across Europe to supply a platform for healthcare professionals to use to increase compliance with the appropriate administration of PAP in European hospitals.