Original Title: Antibioprophylaxie lors de chirurgies du tractus digestif et de la paroi abdominale

Authors' objectives: Surgical site infections (SSIs) are a common complication following surgery and are associated with increased morbidity and high costs for the healthcare system. Among the available prevention strategies, antibiotic prophylaxis—when properly applied—plays a key role in reducing these infections. In Québec, where the fight against antibiotic resistance and the prevention of nosocomial infections are priorities, this work is part of the Institute’s commitment to making recommendations that are up to date and consistent with the latest scientific data and trends in best practices, particularly in antibiotic stewardship. It seeks to equip healthcare professionals and harmonize clinical practices in antibiotic prophylaxis for surgical procedures involving the digestive tract and abdominal wall.

Authors' results and conclusions: RESULTS (#1 TREATMENT PRINCIPLES THAT OPTIMIZE THE EFFECTIVENESS OF SSI PREVENTION): To maximize its effectiveness, antibiotic prophylaxis relies on both the judicious choice of antibiotic and strict adherence to administration timing, which are determining factors in ensuring its preventive effect. (#2 TARGETED ANTIBIOTIC PROPHYLAXIS TO MEET REAL SSI PREVENTION NEEDS WHILE LIMITING ANTIBIOTIC OVERUSE): Antibiotic prophylaxis is not recommended for esophageal and gastroduodenal surgeries without entry into the lumen, low-risk cholecystectomies, proctological surgeries and low-risk hernia repairs. (#3 ADDING ORAL ANTIBIOTIC PROPHYLAXIS IN COLORECTAL SURGERY TO MAXIMIZE SSI PREVENTION): • As a complement to intravenous antibiotic prophylaxis, adding oral antibiotic prophylaxis combined with mechanical bowel preparation the day before colorectal surgery can significantly reduce SSI. • However, limited access to oral neomycin in Quebec, which is only available through compounding, is a potential issue that may limit its use. CONCLUSION: The optimal use guide provides clear recommendations tailored to the clinical context and seeks to optimize the use of antibiotic prophylaxis in general surgery involving the digestive tract and abdominal wall. These recommendations aim to improve SSI prevention while promoting the optimal use of antibiotics. However, the potential impact of these recommendations will depend on the dissemination of the guide accompanying this report and on the adoption of the clinical information and recommendations by healthcare professionals. In this regard, various avenues are suggested to support the recommendations’ implementation in practice.

Authors' recommendations: Triangulating information sources played a central role in critically evaluating and updating the recommendations included in this work. These recommendations are included in sidebars throughout the report and have been incorporated into the optimal use guide, the clinical resource that resulted from this work.

Authors' methods: A systematic review of the literature on best clinical practices in antibiotic prophylaxis in digestive tract and abdominal wall surgery was conducted according to INESSS’s methodological standards. This exercise was supplemented by an analysis of recent systematic reviews focusing specifically on oral antibiotic prophylaxis in colorectal surgery. The recommendations are the result of a rigorous and iterative process, conducted in collaboration with a multidisciplinary advisory committee, that sought to combine scientific, experiential and contextual data in a structured manner. The scientific quality, relevance and applicability of the work were also validated by external readers who are specialists in the field.

Authors' identified further research: The utility of updating the recommendations will be assessed four years from the date of publication of this guide based on advances in scientific data and changes in clinical practices, the inscription of new drugs on the lists or significant changes to the public drug insurance plan’s reimbursement criteria, along with the needs of the health and social services network.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Usage_optimal/ATBprophylaxie_chirurgie_tractus_abdominale_GN_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)