A patient with a nonobstructing carcinoma of the sigmoid colon is being prepared for elective resection. Which of the following reduces the risk of postoperative infectious complications?
The appropriate dosing and timing of antibiotic prophylaxis to prevent surgical site infections in an elective procedure is a single dose, no greater than 1 hour prior to the incision. Additionally, most textbooks recommend use of an oral, nonabsorbable antibiotic regimen effective against aerobes and anaerobes in combination with a mechanical bowel preparation before elective colon resections. There is no evidence to suppo the continuation of antibiotics for more than 24 hours after an elective operation has been completed, and this practice should be avoided to prevent increasing microbial drug resistance. For complex, prolonged procedures, redosing of antibiotics may be appropriate during the procedure based on the drug's halflife. Broad-spectrum antibiotic coverage, including against anaerobic organisms, is required only in cases where such flora are anticipated, such as during colon resections.
A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes
Avoidance of oral antibiotics to prevent emergence of Clostridium difficile
Postoperative administration for 48 hours of parenteral antibiotics effective against aerobes and anaerobes
Postoperative administration of parenteral antibiotics effective against aerobes and anaerobes until the patient's intravenous lines and all other drains are removed
Preoperative assessment and monitoring in anaesthesia