Duración del Uso Ambulatorio de Antibióticos Posquirúrgicos
Resumen
Se realizó una revisión crítica de la literatura sobre la duración del uso ambulatorio de antibióticos después de cirugía, con énfasis en la distinción entre profilaxis y tratamiento. Se efectuó una búsqueda estructurada en PubMed/MEDLINE, Cochrane y documentos normativos internacionales, priorizando guías, revisiones sistemáticas, metaanálisis, ensayos clínicos aleatorizados y cohortes grandes publicadas desde 2008, con verificación de actualizaciones institucionales hasta 2026. La evidencia mostró un consenso: en cirugía limpia y limpia-contaminada la profilaxis debió limitarse al periodo perioperatorio y, en la mayoría de escenarios, no debió continuarse tras el cierre de la herida ni al egreso. La presencia de drenajes, el alta temprana o la preocupación por complicaciones no justificaron por sí mismas antibióticos ambulatorios. En cirugía contaminada o sucia, el enfoque correcto correspondió a tratamiento antimicrobiano guiado por control del foco y cursos cortos. La prolongación rutinaria se asoció con daño ecológico, eventos adversos y costos sin beneficio consistente.
Descargas
Citas
World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2018.
Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91.
National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. London: NICE; 2020 [updated 2023].
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283.
Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74.
Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023;44(5):695-720.
Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, et al. Timing of antimicrobial prophylaxis and the risk of surgical-site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg. 2009;250(1):10-6.
Weber WP, Marti WR, Zwahlen M, Misteli H, Rosenthal R, Reck S, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg. 2008;247(6):918-26.
Branch-Elliman W, O'Brien W, Strymish J, Itani K, Wyatt C, Gupta K. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg. 2019;154(7):590-8.
Clean Cut Investigators Group. An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries. Br J Surg. 2024;111(1):znad438.
Martinez-Sobalvarro JV, Napoleone E, Lopez-Garcia M, et al. Surgical antibiotic prophylaxis and antimicrobial resistance: a systematic review. Int J Clin Pharm. 2022;44(2):301-19.
Sefah IA, Essel G, Kurdi A, et al. Antibiotic prophylaxis for surgical site infections as a risk factor for antimicrobial resistance: a systematic review and meta-analysis. Syst Rev. 2024;13(1):306.
Brocard E, Aiken AM, Haller S, et al. Antibiotic prophylaxis in surgery and its impact on resistance in low- and middle-income countries: a systematic review. Rev Panam Salud Publica. 2021;45:e62.
Tang XF, Zhang JF, Ye ZW, et al. Antibiotic prophylaxis in clean and clean-contaminated surgery and the risk of surgical site infections and adverse events: updated systematic review and meta-analysis. Int J Surg. 2024;110(9):5818-32.
Orelio CC, de Jong M, Daams F, et al. Antibiotic prophylaxis for prevention of postoperative wound infection in adults undergoing open elective inguinal or femoral hernia repair. Cochrane Database Syst Rev. 2020;4(4):CD003769.
Vila PM, Zenga J, Jackson RS. Prophylactic antibiotics in clean-contaminated head and neck surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017;157(4):580-8.
Vander Poorten V, Uyttebroek S, Robbins KT, et al. Antibiotic prophylaxis in clean-contaminated head and neck surgery: a systematic review and meta-analysis. Adv Ther. 2020;37(4):1360-80.
Pivazyan G, German JW, Neifert SN, et al. Utility of prolonged prophylactic systemic antibiotics for wound drains in posterior spine surgery: a systematic review and meta-analysis. J Neurosurg Spine. 2023;38(5):585-94.
Warren DK, Nickel KB, Wallace AE, et al. Postdischarge prophylactic antimicrobial use among women undergoing mastectomy. Infect Control Hosp Epidemiol. 2022;43(10):1382-8.
Hu Y, He J, Jiang L, et al. Postoperative antibiotics and infection rates after implant-based breast reconstruction: a systematic review and meta-analysis. Front Surg. 2022;9:926936.
Sattar AK, Carney MJ, Hauck R, et al. Prophylactic antibiotics after mastectomy with drains but without immediate reconstruction: a multicenter, double-blind, randomized control trial. Ann Surg Oncol. 2023;30(10):5965-73.
Edwards BL, Stukenborg GJ, Brenin DR, Schroen AT. Prophylactic postoperative antibiotics and surgical site infections after mastectomy. Ann Surg Oncol. 2014;21(10):3249-55.
Naimi-Akbar A, Bystedt H, Klinge B, et al. Antibiotic prophylaxis in orthognathic surgery: a complex systematic review. PLoS One. 2018;13(1):e0191161.
Danda AK, Ravi P. Effectiveness of postoperative antibiotics in orthognathic surgery: a meta-analysis. J Oral Maxillofac Surg. 2011;69(10):2650-6.
Milic T, Abu Saleh W, Sàndor GKB, et al. Antibiotic prophylaxis in orthognathic surgery: systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2021;59(6):633-42.
Goormans F, Grisar K, Politis C, et al. Prophylactic antibiotic therapy in maxillofacial trauma: a scoping review and critical appraisal. Antibiotics (Basel). 2022;11(4):483.
Cicuttin E, Cobianchi L, Mazzoni S, et al. Antibiotic prophylaxis in maxillofacial traumatic lesions: a systematic review. Antibiotics (Basel). 2022;11(2):139.
Moharana G, Moharana SS, Swain R, et al. Antibiotic prophylaxis in maxillofacial surgery: systematic review. Cureus. 2025;17(10):e95634.
Yakkanti RR, Miller AO, Vakharia RM, et al. How are oral antibiotics being used in total joint arthroplasty? A review of the literature. J Am Acad Orthop Surg. 2022;30(11):e822-32.
Tidd JL, Bains SS, Buvanendran A, et al. Extended oral antibiotic prophylaxis in total joint arthroplasty: a critical analysis review. JBJS Rev. 2023;11(10):e23.00083.
Kheir MM, Tan TL, Shohat N, Foltz C, Parvizi J. The AAHKS clinical research award: extended oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up. J Arthroplasty. 2021;36(7 Suppl):S18-S25.
Carender NC, Osmon DR, Hanssen AD, Abdel MP, Berry DJ, Mabry TM. Rates of antimicrobial resistance with extended oral antibiotic prophylaxis after total joint arthroplasty. Arthroplast Today. 2022;18:112-8.
Yendluri A, Nandi S, Nicholson M, et al. Oral postoperative antibiotic prophylaxis for outpatient total hip and knee arthroplasty: national practice patterns and impact on periprosthetic joint infection rates. J Arthroplasty. 2024;39(8):1911-6.e1.
Fuqua AA, Johnson AJ, Fruth KM, et al. Not so fast: extended oral antibiotic prophylaxis does not reduce 90-day infection rate following primary total hip arthroplasty. Arthroplast Today. 2025;33:101694.
Fuqua AA, Johnson AJ, Fruth KM, et al. Extended oral antibiotic prophylaxis does not reduce 90-day infection rate following primary total knee arthroplasty. Knee. 2025;56:1-10.
Pisharody VA, Nherera LM, Suleiman LI, et al. Rates of extended oral antibiotic prophylaxis after primary total joint arthroplasty have increased from 2009 to 2022. J Arthroplasty. 2025;40(5):1117-22.
Yoo C, Meneghini RM. Extended oral antibiotics in primary and revision total joint arthroplasty: an update. J Clin Orthop Trauma. 2025;66:103011.
Huston JM, Maier RV, Diaz JJ Jr, et al. The Surgical Infection Society guidelines on the management of intra-abdominal infection: 2024 update. Surg Infect (Larchmt). 2024;25(6):419-35.
Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1-76.
Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Dupont HL, Morrow SE, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372(21):1996-2005.
de Wijkerslooth EML, Bakker OJ, van Rossem CC, et al. 2 days versus 5 days of postoperative antibiotics for complex appendicitis (APPIC): a pragmatic, open-label, multicentre, non-inferiority randomised trial. Lancet. 2023;401(10374):366-76.
de Wijkerslooth EML, Bakker OJ, de Jonge J, et al. Two days versus five days of postoperative antibiotics for complex appendicitis: cost analysis of the APPIC trial. Ann Surg. 2024.
Ramson DM, Davenport M, Bernard J, et al. Duration of postoperative antibiotic therapy after appendicectomy for complex acute appendicitis: a systematic review and meta-analysis. ANZ J Surg. 2021;91(7-8):1397-404.
van den Boom AL, Mauff KAL, van Rossem CC, et al. Postoperative antibiotics and time to reach discharge criteria after appendectomy for complex appendicitis. Dig Surg. 2022;39(4):162-8.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.
Panshin MS, Symer MM, Yeo HL, et al. Postoperative antibiotic duration after appendectomy for complex appendicitis. Am Surg. 2021;87(3):480-5.
Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-27.
Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, et al. Introduction to a compendium of strategies to prevent healthcare-associated infections in acute-care hospitals: 2022 updates. Infect Control Hosp Epidemiol. 2023;44(10):1533-9.
Mertz D, Vicentini C, Lipsky BA, et al. Systematic review and meta-analysis of antimicrobial prophylaxis duration in cardiac surgery. Ann Surg. 2011;254(1):48-54.
Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation. 2000;101(25):2916-21.
Derechos de autor 2026 Evelyn Yulieth Morales Dussan
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
