Colistin for Surgical Site Infections: Evidence-Based Guidelines

Standard SSI Management

• The World Health Organization and other guideline societies recommend immediate surgical drainage as the cornerstone of SSI treatment, with antibiotic selection based on the surgical site and expected pathogens 1, 2, 4
• The Infectious Diseases Society of America recommends oxacillin or first-generation cephalosporins for non-intestinal incisional SSIs in the trunk or extremities, and cefoxitin or ampicillin-sulbactam for SSIs in the axilla or perineum 5, 6

First-Line Antibiotic Choices for SSIs

• The American College of Surgeons recommends broad-spectrum regimens, such as piperacillin-tazobactam, ciprofloxacin, or meropenem plus clindamycin or metronidazole, for necrotizing infections 5, 6, 3
• The Society for Healthcare Epidemiology of America recommends amoxicillin-clavulanate, piperacillin-tazobactam, or ceftriaxone plus metronidazole for empirical coverage of mixed flora 4

Common Pitfalls to Avoid

• The World Health Organization and other guideline societies recommend against using colistin empirically for SSIs, and instead recommend standard guidelines that include oxacillin, cephalosporins, or beta-lactam/beta-lactamase inhibitor combinations as first-line therapy 5, 1, 6, 4
• The Centers for Disease Control and Prevention recommend against delaying surgical drainage, as opening and draining infected wounds is the single most important intervention, and antibiotics alone, including colistin, are insufficient 4