The Global Alliance for Infection in Surgery (GAIS), in collaboration with the Surgical Infection Society Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the World Society of Emergency Surgery (WSES) has presented important recommendations for antibiotic prophylaxis (AP) in traumatic injuries to the head, brain, torso, jaw and face, extremities, skin, and soft tissues.
The guidelines were published online on December 18, 2023 in the Journal of Trauma and Acute Care Surgery by Wolters Kluwer.
The World Health Organization (WHO) emphasizes the importance of administering AP to patients before a surgical incision, depending on the type, timing, and duration of the operation. However, antibiotic misuse is a global problem that poses risks to patient safety and promotes antimicrobial resistance. This problem is due to errors in the selection, dosage, duration, timing, and method of drug administration.
The challenges are particularly pronounced in patients with multiple accompanying injuries, leading to a lack of clear and defined reasoning for the use of antibiotics. Due to difficulties in standardizing definitions and approaches in clinical research, heterogeneous practices prevail.
The guidelines offer specific recommendations for different types of traumatic injuries:
Head and Brain Trauma:
- AP is contraindicated in non-operatively managed patients with blunt head and brain trauma.
- For patients with penetrating head and brain trauma, extended AP (24 hours) is recommended.
Jaw and Facial Trauma:
- AP is recommended for patients with blunt maxillofacial trauma undergoing open fracture reduction.
- AP is recommended for patients with penetrating maxillofacial trauma.
- Extended AP (24 hours) may be considered for patients undergoing open reduction of contaminated wounds.