ImportanceAccording to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as prophylaxis against infection prior to a planned elective procedure is, with rare exception, routinely recommended. The goal of “getting to zero” infections remains a high priority for policymakers, practitioners, and certainly for patients.ObservationsDespite the many advances in surgical technique, skin decontamination, sterile procedure, and enhanced recovery programs, surgical site infections continue to adversely affect procedures as diverse as dental implant surgery, joint arthroplasty, and major abdominal surgery. Although surgical site infection rates are at historically low levels, progress has stalled in recent reporting periods and such infections remain disabling, costly, and occasionally lethal. Stakeholders in the field, including surgeons, infectious diseases specialists, and industry, advocate for strategies emphasizing greater levels of intraoperative sterility or broader-spectrum antibiotic coverage as the most appropriate path forward.Conclusions and RelevanceThe current emphasis on ever-increasing levels of intraoperative sterility and extended-spectrum antibiotic use are not sustainable long-term solutions. Continuing to escalate these approaches may contribute to unintended consequences including antimicrobial resistance. Principles of antimicrobial stewardship and microbiome sciences can be applied to inform a more effective and sustainable approach to infection prevention in the field of surgery.

中文翻译：

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在抗生素耐药性和抗生素管理不断升级的时代预防手术部位感染


重要性根据疾病控制和预防中心以及美国外科医生学会的管理机构的说法，除了极少数例外，通常建议在计划的择期手术之前使用抗生素来预防感染。 “实现零”感染的目标仍然是政策制定者、从业者，当然还有患者的高度优先事项。观察尽管手术技术、皮肤净化、无菌手术和加速康复计划取得了许多进步，但手术部位感染仍然对手术产生不利影响牙科种植手术、关节置换术和腹部大手术等多种多样。尽管手术部位感染率处于历史较低水平，但在最近的报告期内，进展已陷入停滞，此类感染仍然会导致致残、成本高昂，有时甚至致命。该领域的利益相关者，包括外科医生、传染病专家和行业，主张采取强调更高水平的术中无菌或更广谱抗生素覆盖的策略，作为最合适的前进道路。结论和相关性当前对不断提高的术中无菌水平的重视使用广谱抗生素并不是可持续的长期解决方案。继续升级这些方法可能会导致意想不到的后果，包括抗菌素耐药性。抗菌管理和微生物组科学的原理可用于为手术领域的感染预防提供更有效和可持续的方法。