That I know antibiotics are not used for the prevention of infection but for therapy. Best regards :)

Cephazolin.

Check the latest IDSA guidelines from 2013 on surgical prophylaxis- link below

http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2013%20Surgical%20Prophylaxis%20ASHP,%20IDSA,%20SHEA,%20SIS(1).pdf

Cefazolin would be an excellent choice, due to its activity against gram positive cocci.

We aim to reduce the risk of bacteremia and the most likely bacteria to cause a future infection of in situ vascular grafts are those who live in human skin, mainly staph and strepto. It is not necessary to sterilize but to reduce bacterial load.

In institutions with high risk of MRSA infection or in patients with true beta-lactam allergy, vancomycin is an alternative.

I think that this choice should be on the health system, patients profiles and risk factors for SSIs.

The clinical characteristics of patients receiving vascular grafts, often has severe comorbidities including diabetes, renal insufficiency, vascular diseases, immunodeficiency. Aditionally, in some countries deficiency in the health system increase the length of hospital stay before this surgical procedures increasing the opportunities for skin colonization with another pathogens associated to surgical infections 

An interesting question indeed, especially given the high morbidity and the high morbidity associated with prosthetic infection in this group. The latest figures suggest a 50% mortality with aortic prosthetic infection, for instance. Cephalosporins are fine as suggested but do not cover MRSA as outlined (we have moved away from this now with the increased amount of resistance creeping up in this group). This issue was closely looked at by a Working Group at the Royal College of Pathologists led by some eminent microbiologists, and our own antibiotic protocol has evolved following on from the thoughts around their discussions.

We therefore proceed to using either vancomycin or teicoplanin for all procedures involving a prosthetic implant. The key with vancomycin is to administer it at least an hour pre-operatively to achieve appropriate tissue levels factoring in all the other relevant issues e.g. renal function etc as outlined by others above. Therefore, we use mostly a single shot of teicoplanin (our MRSA rate over the last couple of years has been 0 I believe); if, following the basic principles of antibiotic prophylaxis, the operation lasts more than 3 hours then we follow-through with a more prolonged course. This is now protocol in several hospitals I trained at and is certainly the case in my current base, with all the anaesthetists signed up to this. You can make a judgement call as to whether you want additional gram-negative cover or not. Are we going to have an RCT on this? I think not. So this is a presentation of a pragmatic approach based on the common sense application of what we tend to see in this group.

We therefore apply a similar policy to those undergoing procedures with prosthetics in situ. If patients are undergoing bowel surgery you will likely wish to add gram-negative and anaerobe cover as well- I think you get my drift.

Hope that is useful. If people are managing with other protocols, fair enough.

I am a Vascular surgeon.To prevent infection I use  Cephazolin.

I begin one hour before surgery until 24/48h.Generally 24h.