Abstract
Background. Postoperative infections remain a significant cause of morbidity in abdominal surgery, especially in clean-contaminated and contaminated procedures. Third-generation cephalosporins have long been used for surgical prophylaxis because of their broad antimicrobial spectrum and favorable pharmacokinetics. Ceftazidime is notable for its intense activity against Pseudomonas aeruginosa, a relevant pathogen in nosocomial infections. However, earlier clinical experiences were often based on prolonged prophylaxis, whereas current international guidelines (CDC, WHO, ESCMID) recommend limiting prophylaxis to ≤24 hours, requiring a contextual reinterpretation of historical data.
Methods. A retrospective analysis was performed on 409 patients undergoing elective abdominal surgery between January 2020 and December 2024. Procedures included gallbladder (n = 192), colorectal (n = 115), gastric (n = 56), and uterine surgery (n = 46). Approximately half of the patients received perioperative intravenous ceftazidime, while the remainder were treated with alternative beta-lactams (ceftriaxone or piperacillin), selected according to surgical site. Antibiotics were administered 1–2 hours before incision and continued for 3–5 days postoperatively, reflecting standards of care at the time.
Results. Ceftazidime showed efficacy comparable to ceftriaxone in uterine surgery and superior outcomes compared with piperacillin in biliary procedures. In gastric surgery, a lower incidence of postoperative sepsis was observed with ceftazidime. Conversely, in colorectal surgery, ceftazidime demonstrated reduced effectiveness, likely due to inadequate anaerobic coverage, now addressed by regimens combining a cephalosporin with metronidazole. No P. aeruginosa-related respiratory infections occurred in patients receiving ceftazidime.
Conclusions. Ceftazidime is an effective prophylactic agent in selected abdominal surgeries, particularly where antipseudomonal coverage is relevant. Interpreted through contemporary guidelines, these findings highlight the need for site-specific, microbiology-informed prophylactic strategies that account for emerging patterns of antimicrobial resistance.
