Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle

Massimo Sartelli, Federico Coccolini, Francesco M. Labricciosa, Abdel Karim H. Al Omari, Lovenish Bains, Oussama Baraket, Marco Catarci, Yunfeng Cui, Alberto R. Ferreres, George Gkiokas, Carlos Augusto Gomes, Adrien M. Hodonou, Arda Isik, Andrey Litvin, Varut Lohsiriwat, Vihar Kotecha, Vladimir Khokha, Igor A. Kryvoruchko, Gustavo M. Machain, Donal B. O’ConnorIyiade Olaoye, Jamal A.K. Al-Omari, Alessandro Pasculli, Patrizio Petrone, Jennifer Rickard, Ibrahima Sall, Robert G. Sawyer, Orlando Téllez-Almenares, Fausto Catena, Walter Siquini

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean–contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.

Original languageEnglish (US)
Article number100
Issue number1
StatePublished - Jan 2024

Bibliographical note

Publisher Copyright:
© 2024 by the authors.


  • bundle
  • healthcare-associated infections
  • prevention
  • surgical antibiotic prophylaxis
  • surgical site infections

PubMed: MeSH publication types

  • Journal Article
  • Review


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