Surgical Site Infections and Antibiotic Prophylaxis in Surgery: Update 2023

Surgical site infections (SSIs) are superficial or deep infections of the incision site or affecting organ(s) or space(s) close to the surgical site, occurring within 30 days of surgery (90 days in case of prosthetic implantation). SSIs, the most common postoperative complications in the surgical patient (1–15% of surgical cases), are frequently addressed by institutions and scientific societies, with the main aims being clinical improvement, reduction of hospital stay, reduction of post-surgical hospital readmission, reduction of mortality, and cost containment. SSIs, a relevant issue among the Health Care Associated Infections (HCAIs), are usually considered exogenous, being “related” to health care providers, working environment(s), and instrumentations. Recently, pathological modifications of gut microbiota have been gaining a relevant role in SSIs, introducing the potential for an endogenous cause of the infection, in this case sustained by the modified host bacterial flora. The prevention of SSIs, a real risk management operation according to the WHO (World Health Organization), is not related to individual measures but to a “bundle” i.e., a set, of easy-to-implement measures aimed at an indexed goal. “Physical” hygienic measures (bathing/showering/antiseptic preparation of the surgical field/surgical hand preparation) are to be combined with glycemic control, maintenance of normothermia, adequate oxygenation (without hyperoxia), and appropriate surgical antibiotic prophylaxis (SAP), the latter one of the elements of the bundle and not the only one able to impact the occurrence of SSIs. In this review we will discuss SAP protocols for major surgical procedures, antibiotics, timing, and dosages included. Crucial points for successful SSIs control are prospective surveillance, frequent reports dealing with epidemiology, and microorganisms sustaining SSIs in each type of surgery and in each surgical department. Such reports should be provided by the institutions/trusts at least every 2 years and available “standard” schemes should be consequently adapted to the “local” epidemiological data.