Intraoperative Antibiotic Redosing: US Guide

Intraoperative antibiotic redosing guidelines are crucial for maintaining adequate drug concentrations during prolonged surgical procedures, which is a core principle emphasized by the Surgical Care Improvement Project (SCIP). The Centers for Disease Control and Prevention (CDC) offers comprehensive recommendations on infection prevention, including guidance on appropriate antibiotic use in surgery. Pharmacokinetics, the study of drug absorption, distribution, metabolism, and excretion, plays a vital role in determining the timing and dosage of redosing to ensure sustained efficacy. Hospitals across the United States are increasingly adopting these guidelines to minimize the risk of surgical site infections (SSIs), a common postoperative complication.

The Critical Role of Surgical Antibiotic Prophylaxis in Preventing SSIs

Surgical site infections (SSIs) represent a significant and enduring challenge in modern healthcare. Their impact extends beyond patient well-being, imposing substantial economic burdens on healthcare systems worldwide. Understanding the gravity of SSIs and the pivotal role of surgical antibiotic prophylaxis is paramount for optimizing patient outcomes and resource utilization.

The Burden of Surgical Site Infections

SSIs contribute significantly to postoperative morbidity, increasing patient suffering and delaying recovery. They can lead to prolonged hospital stays, readmissions, and the need for further surgical interventions. In severe cases, SSIs can result in life-threatening complications, including sepsis and even death.

The economic consequences of SSIs are also considerable. Increased hospital stay, additional procedures, and the cost of managing complications all contribute to higher healthcare expenditures. Preventing SSIs is, therefore, not only a matter of patient safety but also a crucial aspect of responsible resource management. Effective prophylaxis is a cost-effective intervention.

Surgical Antibiotic Prophylaxis: A Cornerstone of SSI Prevention

Surgical antibiotic prophylaxis involves the administration of antibiotics before surgery to prevent infections at the surgical site. When administered correctly, it significantly reduces the risk of SSI development by suppressing bacterial colonization during the perioperative period. The goal is to achieve adequate antibiotic concentrations in tissues at the time of incision.

However, it's not simply about giving any antibiotic. It’s about using the right antibiotic, at the right dose, and at the right time. Inappropriate or haphazard use of surgical antibiotic prophylaxis can lead to antibiotic resistance and may not effectively prevent SSIs.

Guidelines and Recommendations from Leading Organizations

Several key organizations have developed comprehensive guidelines to support evidence-based surgical antibiotic prophylaxis practices. These guidelines synthesize the best available evidence to provide clear recommendations for antibiotic selection, dosing, and timing. Some of the key organizations include:

• Surgical Care Improvement Project (SCIP): A national initiative focused on improving surgical care and reducing complications, including SSIs.

• Centers for Disease Control and Prevention (CDC): Provides evidence-based recommendations for preventing healthcare-associated infections, including SSIs.

• Infectious Diseases Society of America (IDSA): Develops clinical practice guidelines for the management of infectious diseases, including guidance on surgical antibiotic prophylaxis.

• American Society of Health-System Pharmacists (ASHP): Provides resources and guidelines for pharmacists involved in medication management, including surgical antibiotic prophylaxis.

• American College of Surgeons (ACS): Offers resources and guidance for surgeons on best practices in surgical care, including SSI prevention.

• World Health Organization (WHO): Develops global guidelines and recommendations for infection prevention and control, including surgical antibiotic prophylaxis.

• The Joint Commission: Accredits healthcare organizations and promotes patient safety through standards and performance measurement.

• National Healthcare Safety Network (NHSN): A CDC-managed surveillance system that collects data on healthcare-associated infections, including SSIs.

Evidence-Based Recommendations: Improving Clinical Outcomes

Adherence to established guidelines is crucial for optimizing clinical outcomes. These guidelines provide a framework for selecting appropriate antibiotics based on the surgical site, likely pathogens, and patient-specific factors. They also address important considerations such as dosing adjustments for obese patients and the optimal timing of antibiotic administration.

Implementing evidence-based recommendations translates directly into reduced SSI rates and improved patient well-being. Continuous evaluation of prophylactic practices and adherence to established guidelines are essential components of a successful SSI prevention strategy.

Fundamentals of Surgical Antibiotic Prophylaxis: Choosing the Right Antibiotic, Dosage, and Timing

Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and timing. This section delves into the fundamental principles guiding these critical decisions, emphasizing evidence-based strategies for optimal patient outcomes.

Antibiotic Selection: A Multifaceted Approach

The selection of an appropriate prophylactic antibiotic necessitates a thorough evaluation of several key factors. These include the surgical site, the likely contaminating pathogens, and patient-specific considerations.

Surgical Site and Expected Pathogens

Different surgical procedures carry varying risks of contamination with specific microorganisms. For instance, colorectal surgeries are associated with a higher risk of infection from Gram-negative bacteria and anaerobes, while clean orthopedic procedures are more likely to involve Gram-positive organisms, particularly Staphylococcus aureus.

Understanding the typical microbial flora associated with a particular surgical site is crucial for selecting an antibiotic with appropriate coverage.

Patient-Specific Factors

Patient-specific factors significantly influence antibiotic selection. Allergies are paramount. A documented penicillin allergy, for example, may necessitate the use of alternative agents like vancomycin or clindamycin.

Renal and hepatic function also play a critical role, as these organs are responsible for antibiotic metabolism and excretion. Impaired function may require dosage adjustments to prevent drug accumulation and toxicity.

Finally, the patient's weight is a crucial consideration, particularly in obese individuals, as it can significantly affect antibiotic distribution and require higher doses to achieve adequate serum concentrations.

Commonly Used Antibiotics: A Clinical Arsenal

A range of antibiotics are commonly employed for surgical prophylaxis, each possessing distinct properties and spectra of activity. Some commonly used agents are:

• Cefazolin: Often the first-line choice for many procedures due to its broad Gram-positive coverage and relatively low cost.
• Cefuroxime: A second-generation cephalosporin, sometimes used as an alternative to cefazolin.
• Vancomycin: Reserved for patients with beta-lactam allergies or in institutions with high rates of methicillin-resistant Staphylococcus aureus (MRSA).
• Clindamycin: An option for patients with penicillin allergies, but its use is limited by increasing resistance rates in some areas.
• Gentamicin/Tobramycin: Aminoglycosides that provide Gram-negative coverage; used in combination with other agents.
• Metronidazole: Used primarily for anaerobic coverage, especially in colorectal surgeries.

Timing is Everything: The Importance of Pre-Incisional Administration

The timing of antibiotic administration is paramount for effective surgical prophylaxis. The goal is to achieve adequate antibiotic concentrations in the serum and tissues before the surgical incision is made.

The recommended practice is to administer the prophylactic antibiotic within one hour prior to incision. This timeframe allows for sufficient drug distribution to the surgical site, maximizing its protective effect.

Vancomycin and fluoroquinolones are notable exceptions, requiring infusions 1-2 hours prior to incision.

Dosage Considerations: Weight-Based Dosing in Obese Patients

Accurate antibiotic dosing is essential to achieve therapeutic concentrations and prevent treatment failures. In obese patients, standard weight-based dosing may result in subtherapeutic levels, increasing the risk of SSI.

For cefazolin, the standard adult dose is 2 grams for patients weighing less than 120 kg. Patients who weigh 120 kg or more should receive 3 grams for adequate tissue penetration.

In obese patients, adjusted body weight or other strategies may be necessary to ensure adequate drug exposure. It is important to consult with a pharmacist or infectious disease specialist to determine the optimal dosing strategy for individual patients.

Applying these fundamental principles of antibiotic selection, timing, and dosing is crucial for optimizing surgical antibiotic prophylaxis and minimizing the risk of SSIs.

PK/PD Principles: Understanding Antibiotic Behavior in the Body

Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and timing. This section delves into the fundamental principles guiding these critical decisions, emphasizing the pharmacokinetic (PK) and pharmacodynamic (PD) parameters that dictate effective antibiotic concentrations and ultimately influence redosing strategies during surgical procedures.

Unveiling Pharmacokinetics: How the Body Processes Antibiotics

Pharmacokinetics (PK) describes how the body affects the drug, encompassing the processes of absorption, distribution, metabolism, and excretion (ADME). Understanding these processes is crucial for predicting antibiotic concentrations at the surgical site over time.

• Absorption refers to the process by which the antibiotic enters the bloodstream. For intravenous (IV) administration, absorption is considered complete and immediate, bypassing this stage.

• Distribution involves the movement of the antibiotic from the bloodstream to various tissues and body fluids. Factors like tissue perfusion, protein binding, and the drug's physicochemical properties influence distribution.

• Metabolism is the process by which the body chemically alters the antibiotic, often rendering it inactive or more easily excretable. The liver is the primary site of metabolism for many antibiotics.

• Excretion is the elimination of the antibiotic from the body, primarily via the kidneys (through urine) or the liver (through bile). Renal function significantly impacts the excretion of many antibiotics.

Deciphering Pharmacodynamics: Antibiotic Activity and Bacterial Killing

Pharmacodynamics (PD), conversely, describes how the drug affects the body, specifically the relationship between antibiotic concentration and its antimicrobial effect. This involves understanding how antibiotics interact with bacteria to inhibit growth or cause cell death.

The Minimum Inhibitory Concentration (MIC) is a critical PD parameter representing the lowest concentration of an antibiotic that prevents visible growth of a particular bacterium under standardized conditions. The MIC helps determine the susceptibility of bacteria to a given antibiotic.

Time-Dependent vs. Concentration-Dependent Killing

Antibiotics exhibit different patterns of bacterial killing. Some antibiotics are time-dependent, meaning their efficacy is maximized when concentrations remain above the MIC for a prolonged period. Beta-lactams are a prime example.

Other antibiotics are concentration-dependent, where the rate and extent of bacterial killing increase as the antibiotic concentration increases above the MIC. Aminoglycosides and fluoroquinolones fall into this category.

Key PK/PD Parameters for Redosing Decisions

Two crucial PK parameters heavily influence redosing decisions: Volume of Distribution (Vd) and Half-life (t1/2).

• Volume of Distribution (Vd) represents the apparent space in the body available to contain the drug. A large Vd indicates that the drug is widely distributed into tissues, potentially leading to lower plasma concentrations. Obesity can significantly alter Vd for some antibiotics.

• Half-life (t1/2) is the time it takes for the plasma concentration of a drug to decrease by 50%. Antibiotics with short half-lives require more frequent redosing to maintain adequate concentrations.

Integrating PK/PD Principles into Redosing Strategies

The integration of PK/PD principles is essential for optimizing antibiotic redosing strategies. By understanding how patient-specific factors and surgical characteristics influence antibiotic concentrations, clinicians can make informed decisions about the timing and dosage of intraoperative redosing.

For example, procedures with significant blood loss may necessitate earlier redosing due to a reduction in antibiotic concentrations. Similarly, patients with impaired renal function may require less frequent redosing to avoid drug accumulation and toxicity.

Ultimately, applying PK/PD principles helps ensure that adequate antibiotic concentrations are maintained at the surgical site throughout the procedure, maximizing the likelihood of preventing SSIs and improving patient outcomes.

Redosing Triggers: Identifying Factors That Influence the Need for Intraoperative Antibiotic Re-administration

Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and timing. This section delves into the fundamental principles guiding these critical decisions, emphasizing the pharmacokinetic (PK) and pharmacodynamic (PD) factors that dictate the necessity for intraoperative antibiotic re-administration. Understanding these triggers is paramount to maintaining adequate antibiotic concentrations at the surgical site throughout the procedure.

The Multifaceted Nature of Redosing Triggers

The decision to re-dose antibiotics during surgery is not arbitrary. Instead, it is a calculated assessment influenced by a confluence of patient-specific and surgical variables. These factors impact the pharmacokinetic profile of the administered antibiotic, potentially leading to subtherapeutic concentrations if not addressed proactively.

Patient factors include renal function and body mass index (BMI), while surgical factors encompass anesthesia duration and intraoperative blood loss. A comprehensive evaluation of these elements is essential for individualized antibiotic redosing strategies.

Impact of Impaired Renal Function on Antibiotic Clearance

Renal function significantly impacts the clearance of many antibiotics, particularly those primarily excreted by the kidneys. Impaired renal function, whether pre-existing or acute, prolongs the half-life of renally cleared antibiotics.

This necessitates careful consideration of dosing intervals and potential dose adjustments to prevent drug accumulation and toxicity, while ensuring therapeutic concentrations are maintained. Creatinine clearance (CrCl) is a key metric for assessing renal function and guiding redosing strategies.

Obesity and Altered Volume of Distribution

Obesity substantially alters the volume of distribution (Vd) for many antibiotics. Lipophilic antibiotics tend to distribute more extensively into adipose tissue in obese patients, potentially leading to lower serum concentrations relative to lean body mass.

Therefore, weight-based dosing, often utilizing adjusted body weight or ideal body weight, is crucial in obese patients to ensure adequate drug exposure. Simple extrapolation from standard dosing regimens based on total body weight may result in sub-therapeutic antibiotic concentrations.

Anesthesia Duration and Redosing Intervals

The duration of anesthesia directly correlates with the need for intraoperative antibiotic redosing. Most prophylactic antibiotics have half-lives ranging from 1 to 3 hours.

As a general rule, redosing should be considered when the duration of surgery exceeds two half-lives of the administered antibiotic. Shorter-acting agents may necessitate more frequent redosing to ensure continuous coverage throughout the surgical procedure.

Blood Loss and Antibiotic Concentrations

Significant intraoperative blood loss can substantially decrease antibiotic concentrations at the surgical site. Blood loss leads to a direct reduction in the circulating antibiotic volume, potentially compromising the effectiveness of prophylaxis.

In cases of substantial blood loss (e.g., > 1500 mL), administering a supplemental dose of the prophylactic antibiotic is generally warranted. Accurate estimation of blood loss is critical for determining the appropriate redosing strategy.

Optimizing Redosing Strategies: Tools and Technologies for Enhanced Antibiotic Administration

Redosing Triggers: Identifying Factors That Influence the Need for Intraoperative Antibiotic Re-administration Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and timing. This section delves into the fundamental principles guiding these critical decisions, paving the way for a discussion on how to optimize antibiotic redosing strategies. By integrating real-time assessment, advanced technologies, and streamlined communication, healthcare professionals can significantly enhance the effectiveness of intraoperative antibiotic administration.

The Imperative of Real-Time Assessment and Communication

Effective antibiotic redosing hinges on the surgical team's ability to conduct real-time assessments of factors impacting antibiotic concentrations.

This includes monitoring estimated blood loss, assessing fluid shifts, and closely tracking the duration of surgery.

Seamless communication amongst surgeons, anesthesiologists, and pharmacists is paramount.

A shared understanding of these factors enables proactive redosing decisions, ensuring adequate antibiotic coverage throughout the procedure.

Leveraging Electronic Health Records (EHRs) for Enhanced Tracking

Electronic Health Records (EHRs) serve as invaluable tools for tracking antibiotic administration.

EHR systems can be configured to automatically record the time of initial antibiotic administration and calculate appropriate redosing intervals based on pre-defined protocols.

Furthermore, EHRs can generate alerts to notify the surgical team when redosing is due, minimizing the risk of missed doses.

Standardized documentation within the EHR also facilitates post-operative analysis and quality improvement initiatives.

Clinical Decision Support Systems (CDSS) for Real-Time Recommendations

Clinical Decision Support Systems (CDSS) represent a cutting-edge approach to optimizing antibiotic redosing.

These systems leverage patient-specific data, such as weight, renal function, and surgical duration, to provide real-time recommendations for antibiotic dosing and redosing.

CDSS algorithms can incorporate PK/PD principles to predict antibiotic concentrations and tailor dosing regimens to individual patient needs.

By integrating CDSS into the surgical workflow, healthcare professionals can make more informed decisions and minimize the risk of sub-therapeutic antibiotic levels.

Pharmacokinetic/Pharmacodynamic (PK/PD) Modeling for Enhanced Dosing Precision

Pharmacokinetic/Pharmacodynamic (PK/PD) modeling offers a sophisticated approach to optimizing antibiotic dosing strategies.

PK/PD models simulate the movement of antibiotics throughout the body (pharmacokinetics) and their effect on bacteria (pharmacodynamics).

These models can be used to predict antibiotic concentrations at the surgical site and determine the optimal dosing regimen to achieve desired bacterial killing.

While requiring specialized expertise, PK/PD modeling can be particularly valuable in complex cases, such as obese patients or those with renal impairment, where standard dosing guidelines may be insufficient.

Continuous Infusion Antibiotics: An Alternative Dosing Strategy

Continuous infusion antibiotics represent an alternative dosing strategy that may be beneficial in certain situations.

Instead of intermittent bolus doses, antibiotics are administered continuously over a prolonged period, maintaining consistent drug levels.

Advantages:

• Potentially improved PK/PD target attainment
• Reduced fluctuations in antibiotic concentrations
• Simplified administration in some cases

Disadvantages:

• Increased risk of catheter-related infections
• Potential for drug instability
• Requires careful monitoring and specialized equipment
• Not suitable for all antibiotics

The decision to use continuous infusion antibiotics should be made on a case-by-case basis, considering the specific antibiotic, patient factors, and surgical procedure.

Antimicrobial Stewardship: Minimizing Resistance Through Responsible Antibiotic Use

Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and redosing. However, the escalating threat of antimicrobial resistance necessitates a parallel focus: antimicrobial stewardship. By optimizing antibiotic use, we not only protect individual patients but also contribute to the long-term effectiveness of these vital medications.

The Critical Role of Antimicrobial Stewardship Programs (ASPs)

Antimicrobial stewardship programs (ASPs) are structured initiatives designed to promote the appropriate use of antibiotics.

ASPs play a central role in ensuring that antibiotics are prescribed only when necessary. They also help to ensure that the right drug, dose, and duration are selected.

By implementing evidence-based guidelines and monitoring antibiotic usage patterns, ASPs can reduce unnecessary antibiotic exposure and minimize the selective pressure that drives resistance. This includes active prospective audit and feedback strategies for surgical prophylaxis.

Prioritizing Narrow-Spectrum Antibiotics

A fundamental principle of antimicrobial stewardship is selecting the narrowest spectrum antibiotic that is effective against the likely pathogens. Broad-spectrum antibiotics, while tempting in their ability to cover a wide range of bacteria, exert a greater selective pressure, promoting the emergence of resistance.

When Cefazolin, a first-generation cephalosporin, provides adequate coverage for the anticipated pathogens in a clean surgical procedure, it should be favored over broad-spectrum alternatives like carbapenems. This approach minimizes the disruption to the patient's microbiome and reduces the risk of selecting for resistant organisms.

Leveraging Breakpoint and Antibiotic Susceptibility Testing (AST)

Antibiotic Susceptibility Testing (AST) is crucial in guiding antibiotic selection, especially in situations where resistance is suspected or confirmed. AST results determine whether a particular bacteria is susceptible, intermediate, or resistant to an antibiotic.

Breakpoints, established by organizations like CLSI or EUCAST, are critical values used to interpret AST results.

These breakpoints define the concentration of an antibiotic that is expected to inhibit the growth of a susceptible bacterium.

Clinicians must consider these breakpoints and AST results when selecting antibiotics, particularly when treating established infections. However, the predictive value for prophylaxis is limited, so guidelines and hospital antibiograms are preferred for prophylactic antibiotic selection.

The Escalating Impact of Resistance on Prophylactic Strategies

The rise of antibiotic resistance poses a significant challenge to surgical prophylaxis. Increasing rates of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae limit the effectiveness of commonly used prophylactic antibiotics.

In some cases, alternative agents like vancomycin or carbapenems may be necessary, but these should be used judiciously to avoid further driving resistance.

Furthermore, the emergence of multidrug-resistant organisms (MDROs) may necessitate more complex prophylactic regimens, potentially involving combinations of antibiotics. Prudent use is essential to avoid compromising treatment options, and antibiograms should guide prophylaxis decision-making.

Continuous surveillance of resistance patterns and adaptation of prophylactic protocols are essential to maintaining effective SSI prevention.

Antimicrobial Stewardship: Minimizing Resistance Through Responsible Antibiotic Use Surgical antibiotic prophylaxis stands as a cornerstone in preventing SSIs, requiring a meticulous approach to antibiotic selection, dosing, and redosing. However, the escalating threat of antimicrobial resistance necessitates a parallel focus: antimicrobial stewardship. The efficacy of any prophylactic strategy hinges not just on pharmacological precision, but also on the coordinated efforts of the entire surgical team.

The Surgical Team's Collaborative Responsibility: A Coordinated Approach to Prophylaxis

Effective surgical antibiotic prophylaxis transcends individual actions, demanding a tightly orchestrated collaboration among all members of the surgical team. The synergistic contributions of surgeons, anesthesiologists, pharmacists, operating room nurses, and infection control practitioners are pivotal in minimizing SSIs and ensuring optimal patient outcomes. Each role carries distinct responsibilities that, when seamlessly integrated, form a robust defense against post-operative infections.

Surgeons: Orchestrating Prophylaxis

The surgeon bears the primary responsibility for initiating appropriate antibiotic prophylaxis. This begins with a thorough preoperative assessment, considering the surgical site, patient-specific risk factors, and the likely pathogens involved.

The surgeon must ensure that an appropriate antibiotic is selected and ordered, adhering to established guidelines and institutional protocols. Clear communication with the anesthesiologist and pharmacist is crucial to confirm the chosen agent aligns with the patient's allergies, comorbidities, and concurrent medications.

Furthermore, the surgeon plays a critical role in communicating the expected duration of the procedure. This information is vital for determining the need for intraoperative redosing.

Anesthesiologists: Managing Medications and Monitoring

Anesthesiologists are instrumental in the timely and accurate administration of prophylactic antibiotics. They are responsible for confirming the correct dosage, route, and timing of administration, typically within one hour prior to surgical incision.

During the procedure, anesthesiologists must diligently monitor vital signs and fluid balance. This is to identify factors that could affect antibiotic pharmacokinetics, such as hypotension or significant blood loss.

Open communication with the surgeon and pharmacist is essential to address any concerns regarding drug interactions, adverse reactions, or the need for redosing based on the procedure's progress or patient's physiological status.

Pharmacists: The Antibiotic Experts

The pharmacist serves as the resident expert on antibiotic selection, dosing, and administration. Their role extends beyond dispensing medications to actively participating in the prophylaxis planning process.

Pharmacists can provide valuable guidance on the most appropriate antibiotic based on the surgical procedure, local resistance patterns, and patient-specific factors such as allergies, renal function, and weight.

They are also crucial in calculating weight-based dosages, particularly in obese patients, and in advising on optimal redosing strategies based on pharmacokinetic principles. Pharmacists play a key role in antimicrobial stewardship, promoting the judicious use of antibiotics and minimizing the risk of resistance.

Operating Room Nurses: Vigilant Administration and Monitoring

Operating room nurses are at the forefront of medication administration and patient monitoring. They are responsible for verifying the antibiotic order, preparing the medication, and administering it according to established protocols.

Nurses also play a vital role in documenting the timing and dosage of antibiotic administration in the patient's medical record.

Careful observation for any signs of adverse reactions to the antibiotic, such as allergic reactions, is paramount. They serve as a critical link in the communication chain, alerting the surgeon, anesthesiologist, or pharmacist to any concerns.

Infection Control Practitioners: Surveillance and Prevention

Infection control practitioners play a crucial role in monitoring SSI rates, identifying trends, and implementing preventive measures. They collect and analyze data on SSIs, providing valuable feedback to the surgical team on the effectiveness of prophylactic strategies.

They develop and implement protocols for surgical site preparation, hand hygiene, and environmental cleaning. Infection control practitioners also educate healthcare personnel on best practices for SSI prevention and antimicrobial stewardship.

Their expertise is invaluable in developing and maintaining a culture of safety and continuous improvement within the surgical environment.

Fostering Seamless Communication

The linchpin of a successful collaborative approach is effective communication. Regular meetings, clear lines of communication, and a shared understanding of roles and responsibilities are essential to ensure that all members of the surgical team are working towards the same goal: preventing SSIs and optimizing patient outcomes. Standardized protocols, checklists, and electronic health record systems can further enhance communication and coordination, ensuring that all critical steps in the prophylaxis process are consistently followed.

So, there you have it – a quick rundown of intraoperative antibiotic redosing guidelines in the US. Hopefully, this helps clear up any confusion and ensures we're all doing our best to keep our patients safe and infection-free during surgery!