Antibiotic Timing Prior to Surgery Matters!

Reviewed by Cindy Noyes, MD, University of Vermont Medical Center

A large, prospective cohort study in Switzerland conducted from January 2009 to December of 2020 included 222,439 patients from 158 hospitals and assessed timing of pre-operative cefuroxime antibiotic prophylaxis (0-30 minutes(mins), 31-60 mins or 60-120 mins) and surgical site infection (SSI) incidence.1  The cohort included all patients undergoing common surgeries comprising of C-section, total knee and hip replacement, cardiac surgery, gastric bypass, hernia repair, hysterectomy, laminectomy, among others.1  A statistically significant lower odds of SSI was noted when prophylactic antibiotics were administered 0-30 mins prior to incision as compared 60-120 minutes.1  The lowest rate of SSI in this strata receiving prophylaxis 0-30 mins prior to incision was identical to a report of a historical cohort described by Steinberg and colleagues in 2009 who conducted a similar study in multiple centers in the United States and revealed that for patients receiving cephalosporins, the incidence of SSI was lowest in those who received antibiotic prophylaxis 30 minutes or less prior to incision.1,2  This further reinforces that timing of antibiotic prophylaxis significantly influences SSI outcome.  


  1.  Sommerstein R, et al.  Timing of cefuroxime surgical antimicrobial prophylaxis and its association with surgical site infections.  JAMA Network Open.  2023; 6(6): e231370
  2. Steinberg J, et al.  Timing of antimicrobial prophylaxis and the risk of surgical site infection.  Annals of Surgery.  2009: 250 (1): 10-16.
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