[Antimicrobial prophylaxis in clean surgery].

Antibiotic prophylaxis in clean surgery is generally not required except for prosthetic cardiac, vascular and orthopedic surgery. In these cases, the cephalosporins mostly active against staphylococci such as cefazolin, cefuroxime and cefamandole or antistaphylococcal penicillins, such as oxacillin, associated or not with aminoglycosides, are recommended. The progressive increase of methicillin-resistant staphylococci has led to use for the above mentioned surgeries also glycopeptides, especially in those wards where methicillin resistance is particularly high. Nevertheless, not enough many prospective-controlled studies have been carried on to evaluate whether glycopeptides reduce the risk of post-surgical infections, more than other conventional antibiotic regimens. Further, the possible risk of selecting glycopeptide-resistant enterococci suggests that prophylactic use of glycopeptides should be limited and a minimal number of doses should be administered, favouring whenever possible, the ultra short term prophylaxis (single dose).