• Infection post surgery is costly and distressing
• Infection in major vascular surgery is potentially limb or life-threatening
• Current post surgical infection rates in vascular patients at GHH are < 3%
• Rationalising prophylactic prescribing regimes aims to keep these rates low
• Pitt et al¹ showed reduced infection with 24 hours prophylactic antibiotics
• Kaiser et al² also demonstrated reduced infection rates using 24 hours of cefazolin during major vascular procedures
• Bratzler et al³ showed there was a significant reduction in infection rates if the antibiotics were given 60 minutes prior to the incision
• Harbarth et al⁴ showed that prolonged antibiotic prophylaxis increases antibiotic resistance

Guidelines

• Give 3 doses of 1.2g IV Co-amoxiclav (Augmentin)
• First dose given on induction, preferably 1 hr prior to incision
• Consider vancomycin 1g IV plus ciprofloxacin 400mg IV in patients with beta-lactam allergy

Inclusion Criteria

• All patients undergoing major vascular procedure
• Any patient having insertion of prosthetic material

Exclusion Criteria

• Any patient with evidence of active infection at time of procedure
• Any patient prescribed antibiotics prior to surgery
• Previous history of graft or Hickman line infection
• Patient with MRSA colonisation
• Contact microbiologist for advice