Prophylactic antibiotic use in four Dublin teaching hospitals

Prophylactic antibiotics in cataract operations

The rationale for prophylactic antibiotics in cataract operations must be continually reevaluated in light of cost-effectiveness and adverse reactions. The principles learned from wound infections associated with general surgical procedures should be applied to the limited knowledge about the rare event of endophthalmitis. Herein the literature on experimental and clinical wound infections in general surgical procedures is reviewed, with analysis of microbial flora, pathophysiology of wound infections, and pharmacokinetics of antibiotics. Experimental and clinical studies on prophylactic antibiotics to prevent endophthalmitis are reviewed, including information on topically applied antibiotics, chemical antisepsis, and administration of subconjunctival, intracameral, and systemic antibiotics. In addition, the benefits, limitations, and risks of the various types of prophylactic antibiotics are discussed. Because of the limited data on prophylactic antibiotics in cataract operations, providing dogmatic statements is difficult. General recommendations are offered based on the currently available literature, and a stratified approach is suggested based on wound construction and number of anterior segment maneuvers.

Administration of heparin and antibiotic prophylaxis

An audit was performed to examine the time of administration of heparin and antibiotic prophylaxis to patients at risk of deep vein thrombosis, pulmonary embolism and post-operative wound infection. The records of 648 consecutive patients undergoing major surgery within a 12-month period were reviewed retrospectively. Heparin prophylaxis was given before surgery to only 30.9 per cent of patients undergoing elective procedures and in only 22.7 per cent of emergencies. Antibiotic prophylaxis was given before operation or at induction of anaesthesia to 82.1 per cent of patients undergoing elective procedures and in only 72.1 per cent of emergencies. It is concluded that administration of heparin and antibiotic prophylaxis is inadequate despite the provision of a written protocol.