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Children. J Laparoendosc Adv Surg Tech A 2010,20(4):369–372.PubMedCrossRef Competing interests The authors declare that they have no competing interests. Authors’ contributions OFE was involved in postoperative care, conceived the write up, performed the literature search and manuscript preparation. AAA performed the operation with TWD, involved in the preoperative and postoperative care, conceived the write up, performed the literature Ibrutinib cell line search and manuscript preparation. TWD performed the operation with AAA, involved in the preoperative and postoperative care, conceived the write up, performed the literature search and manuscript preparation. All authors read and approved the manuscript for submission.”
“The principles of perioperative antimicrobial

prophylaxis were established more than 40 years ago [1]. This concept has been applied to many areas of surgery and numerous prospective randomized trials have repeatedly demonstrated that surgical site Vemurafenib in vitro infections (SSIs) are reduced when the right antibiotics are administered appropriately. This practice has been incorporated into standardized guidelines for perioperative use through the Surgical Care Improvement Project (SCIP) and serves as a major process measurement FER for appropriateness of practice [2]. First and second generation cephalosporins have been the major drug class recommended and used for prophylaxis for decades and there has been little change in these recommendations

over time. Recent reports have demonstrated a lack of correlation between the use of guideline-directed perioperative antimicrobial prophylaxis, that is, administration of the right drug at the right time for the right duration and its primary outcome measure, prevention of SSI [3, 4]. This begs the question: could we have been wrong about the benefits of perioperative antimicrobial prophylaxis? There are a number of potential explanations for these observations. This principle has been so widely accepted that some propose that all patients receive antimicrobial prophylaxis regardless of the operation and risk of infection [5]. This concept fails to consider the risk: benefit ratio of even single dose drug use, since there is a small but defined risk of allergic and other adverse reactions associated with most antibiotics. Overuse blurs the advantage of prophylaxis, as many who wouldn’t benefit would still receive prophylaxis and supports the concept of unrelated attribution.