Search Results (204)

Background: Metabolic and bariatric surgery is an established therapeutic option for severe obesity and obesity-related medical problems. Although minimally invasive techniques and enhanced recovery pathways have reduced postoperative morbidity, infectious complications remain clinically relevant because they may lead to readmission, reoperation, prolonged antimicrobial therapy, and mortality. Methods: We conducted a narrative review of the literature on infectious complications after metabolic and bariatric surgery. Evidence was synthesized across five clinically relevant domains: host-related pathophysiology, microbial epidemiology, preoperative optimization, antimicrobial prophylaxis and pharmacokinetic considerations, and diagnosis and management of postoperative infectious complications. Results: Patients with obesity present specific infection-related vulnerabilities, including chronic low-grade inflammation, altered immune responses, impaired tissue oxygenation, obesity-related medical problems, and procedure-specific risks. Contemporary prevention relies on multidisciplinary preoperative optimization, appropriate skin antisepsis, weight-based antimicrobial prophylaxis, intraoperative redosing when indicated, and adherence to enhanced recovery principles. Anastomotic leaks and intra-abdominal abscesses represent the most severe organ/space infections and require early recognition, source control, antimicrobial therapy, nutritional support, and coordinated surgical, radiological, and endoscopic management. Conclusions: Infectious complications after metabolic and bariatric surgery result from the interaction between host physiology, microbial factors, pharmacological considerations, and surgical technique. A structured approach integrating prevention, early diagnosis, and multidisciplinary management may improve outcomes. Further bariatric-specific studies are needed to strengthen the evidence base for several preventive and therapeutic strategies. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background: Perioperative antibiotic prophylaxis (PAP) is effective for infection prevention in implant-related surgery, with infections being the most feared complications. A total of 15% of all antibiotics in hospitals are used for surgical prophylaxis but less than 50% of them are used according to the guidelines. International guidelines recommend only a single preoperative dose for all surgical procedures. We have developed and implemented new recommendations for PAP duration in primary hip and knee arthroplasty at the University Department for Orthopaedic Surgery. Methods: The development and implementation of new recommendations regarding PAP duration were performed via the following steps: pre-interventional analysis; identification of barriers and facilitators using the Flottorp framework; analyzing the data and preparation of a tailored implementation strategy based on an educational group meeting with the development of new consented to recommendations; and dissemination; followed by postinterventional analysis of PAP duration compliance 6 months later. Results: Before the intervention, 70% of PAP was used inappropriately (longer than 24 h). The major recognized barriers were fear of prosthetic joint infection (PJI) and a lack of concern regarding global antimicrobial resistance problems. Major facilitators were a low local PJI incidence rate (0.28%), etiology of PJI and existing local experience with a single-dose regime. After implementation of new recommendations regarding the duration of PAP, the postinterventional analysis showed that 80% of PAP was used according to the new recommendations, with a significant reduction in prolonged PAP use (from 70% to 12%), leading to an important decline in antimicrobial consumption. Conclusions: Our study showed that a tailored strategy in the development and implementation of new recommendations is complex and time consuming, although necessary for successful clinical practice change. Full article

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015–2024 was performed, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Consensus was predefined as ≥90% agreement. Seven evidence-based consensus statements were developed addressing: (1) periodontal risk assessment using validated tools; (2) guided bone regeneration outcomes with technique-specific indications; (3) comparative survival of four versus six implants in mandibular full-arch rehabilitations; (4) equivalence of tilted and axial implant configurations; (5) prosthetic material selection, with monolithic zirconia showing high survival; (6) risk-stratified supportive maintenance protocols associated with a reduction in peri-implantitis incidence; and (7) systemic risk stratification, including absolute and relative contraindications, medication-related osteonecrosis of the jaw (MRONJ) risk management, and perioperative antibiotic prophylaxis. Full article

Background: Kounis syndrome is an allergic acute coronary syndrome precipitated by coronary vasospasm, plaque destabilization, stent thrombosis, or bypass occlusion. Cardiac surgery represents a uniquely high-risk setting due to cardiopulmonary bypass–associated inflammation and exposure to multiple pharmaceutical agents. Importantly, Kounis syndrome remains underrecognized in this context, as classical signs of anaphylaxis may be masked under general anesthesia and cardiopulmonary bypass, while ischemic manifestations may be misattributed to other perioperative conditions. Methods: A narrative review of PubMed-indexed literature was conducted to synthesize current evidence on the pathophysiology, perioperative triggers, clinical presentation, diagnostic strategies, and management of Kounis syndrome in cardiac surgery, with emphasis on intraoperative recognition and surgical decision-making. Published cases were retrieved involving perioperative cardiac surgery patients with a definite diagnosis of Kounis syndrome. Additionally, cases presenting with severe perioperative anaphylaxis and life-threatening cardiovascular involvement (grade III with cardiovascular collapse and grade IV with cardiac arrest) were included as possible Kounis syndrome, reflecting real-world diagnostic uncertainty in the intraoperative setting. Results: The literature review identified five cases of definite Kounis syndrome and ten cases of possible Kounis syndrome, including three cases with cardiovascular collapse and seven cases with cardiac arrest. Recurrent episodes were reported in several patients, particularly due to re-exposure to the triggering agent. In the context of cardiac surgery, Kounis syndrome is most frequently triggered by chlorhexidine, protamine, antibiotic prophylaxis, and anesthetic agents. The clinical presentation is often subtle during cardiopulmonary bypass. Vasoplegia, pulmonary hypertension, ventricular dysfunction, new regional wall-motion abnormalities, and hyperdynamic ventricles on transesophageal echocardiography commonly precede overt electrocardiographic changes. Diagnosis is primarily clinical and relies on intraoperative ultrasound, hemodynamic monitoring, serum tryptase, serum troponin, and, when indicated, coronary angiography. A dual-pathway approach addressing both anaphylaxis and myocardial ischemia is essential; however, one component may predominate, particularly in perioperative patients with limited clinical information, potentially leading to misdiagnosis. A multidisciplinary approach is therefore required for rapid diagnosis and individualized management. In refractory cases, cardiopulmonary bypass or ventricular assist devices may provide lifesaving support. Conclusions: Kounis syndrome remains underrecognized in cardiac surgery but carries significant morbidity. Increased clinical awareness, multidisciplinary collaboration, structured diagnostic approaches, and preventive strategies are essential to improve outcomes and reduce the risk of recurrence during future procedures. Full article

Background/Objectives: Primary non-refluxing megaureters (PM) are common congenital anomalies of the urinary tract. While spontaneous resolution is frequent, reliable non-invasive predictors of outcome are scarce. Ureteral peristalsis is frequently regarded as a sign of functional maturation and favorable prognosis, although supporting clinical evidence is limited. This study aimed to evaluate whether sonographically visible ureteral peristalsis at initial diagnosis predicts spontaneous resolution, pyelonephritis, or the need for surgery in infants with PM. Methods: In this retrospective single-center study, infants diagnosed with primary non-refluxing megaureters before one year of age between 2012 and 2018 were analyzed. Patients with refluxing, secondary, syndromic, or ectopic megaureters were excluded. Sonographic detection of distal ureteral peristalsis at initial examination was recorded. Clinical outcomes included spontaneous resolution, episodes of pyelonephritis (including breakthrough infections under antibiotic prophylaxis), and surgical intervention. Univariate and multivariate logistic regression analyses were performed. Results: Sixty-three infants were included, with a median follow-up of 34 months. Peristalsis was detected in 52.3% at initial ultrasound. Complete spontaneous resolution occurred in 66% of patients, while 20.9% required surgical reimplantation. The presence of peristalsis at diagnosis was not associated with spontaneous resolution, time to resolution, occurrence of pyelonephritis, breakthrough infections, or surgical intervention. Multivariate analysis confirmed that initial peristalsis was not an independent predictor of outcome. Conclusions: Sonographically visible ureteral peristalsis is a transient and inconsistent finding in infants with primary non-refluxing megaureters and does not predict clinical outcome. Peristalsis observed on initial ultrasound should not be used as a decision-making parameter in the management of PM during the first year of life. Full article

Background/Objectives: Surgical site infection (SSI) remains a significant complication following spine surgery, yet the optimal duration of prophylactic antibiotic administration remains debated. We investigated the association between prophylactic antibiotic duration and SSI rates following spine surgery using a nationwide claims database. Methods: This retrospective cohort study analyzed data from the Health Insurance Review and Assessment Service quality assessment database across four assessment waves (2014–2020, sixth to ninth). Adult patients (aged ≥19 years) undergoing elective spine surgery (decompression, instrumented fusion, vertebroplasty, or kyphoplasty) were categorized into two groups based on prophylactic antibiotic duration: <24 h or ≥24 h. Surgery type was the primary surgical categorization, while surgery site (cervical, thoracic, lumbar) was assessed separately in supplemental analyses. Primary outcomes included SSI, non-surgical-site infections, and total postoperative infections within 3 months. Multivariable logistic regression was performed to identify independent predictors of infection. Results: Of 82,840 patients included, 19,988 (24.1%) discontinued prophylactic antibiotics within 24 h and 62,852 (75.9%) continued antibiotics for ≥24 h. The <24 h group demonstrated significantly lower SSI rates compared to the ≥24 h group (0.16% vs. 1.47%, p < 0.05). After adjustment for confounders, prolonged antibiotic prophylaxis (≥24 h) was associated with increased odds of SSI (adjusted odds ratio [aOR] = 10.73, 95% CI = 7.30–15.79), non-surgical-site infections (aOR = 16.06, 95% CI = 13.11–19.67), and total postoperative infections (aOR = 17.82, 95% CI = 14.83–21.42). Conclusions: In this nationwide cohort, early discontinuation of prophylactic antibiotics within 24 h was not associated with increased SSI risk. Prolonged antibiotic prophylaxis beyond 24 h was associated with higher SSI rates, although confounding by indication likely contributed to this finding. These results are consistent with current guideline recommendations for limiting prophylactic antibiotic duration to 24 h or less in routine spine surgery, while recognizing that individualized approaches may be warranted in some high-risk patients. Full article

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome. Full article

Background: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCAIs) worldwide. Changes in the functioning of healthcare systems may affect the implementation of SSIs prevention practices, with consequent alterations in the occurrence of HCAIs. The main aims of our study were to analyze specific SSIs prevalence and proportions together with overall HCAIs prevalence in acute care hospitals (ACHs) before and after the COVID-19 pandemic. Additional aims were to identify bacterial causative agents, the use of perioperative antibiotic prophylaxis (PAP), related structural and process quality indicators, and to determine trends between two periods. Methods: The National Reference Centre for HCAIs (University Hospital Centre Zagreb) conducted point prevalence surveys in May 2017 and May 2023 in ACHs throughout Croatia, using the technical protocol developed by the European Centre for Disease Prevention and Control (ECDC). Results: The prevalence of HCAIs in ACHs in Croatia rose from 5.3% (95% CI 4.8–5.7) in 2017 to 7.2% (95% CI 6.6–7.8) in 2023 (p = 9.93 × 10⁻¹⁴). This trend was paralleled with the rising of the HCAIs prevalence in surgical departments from 5.1% to 6.7% (p = 0.0099). The prevalence of overall SSIs across ACHs increased from 0.9% (95% CI 0.7–1.1) in 2017 to 1.2% (95% CI 1.0–1.5) in 2023 (OR 1.36 (1.03–1.80), p = 0.032. While the prevalence of superficial incisional SSIs significantly decreased (OR 0.53 (0.30–0.95), p = 0.028), the share of deep-seated SSIs (deep incisional and organ/space SSIs) among classified SSIs shifted from 48/92 to 77/96; odds ratio (OR) 2.09 (95% CI 1.45–3.01). In 2017, Gram-positive cocci were the most frequently isolated bacterial causative agents (44.6%). By 2023, this shifted, with Enterobacterales species comprising most isolates (42.2%). In 2023, significantly a higher proportion of patients received PAP (χ² = 25.419, df = 1, p  < 0.5). An increase in the positive trend of alcohol-based hand rub antiseptics use in surgical departments (+15.7 L/patient-days, p < 0.001) contrasted with a decrease in infection prevention and control (IPC) nurses and medical doctors per hospital (−0.5, p = 0.041/−0.5, p = 0.003). Conclusions: Findings of the two point prevalence surveys over time indicate the changes in trends in surgical site infections burden, and highlight the need for the implementation and strengthening of preventive measures with the focus on targeted prevention of deep-seated infections. Full article

Background: Pancreatoduodenectomy (PD) remains the fundamental treatment for periampullary malignancies but is associated with considerable morbidity (20–50%) and mortality (2–7%). Bacteriobilia contributes to unfavourable postoperative outcomes. Current antibiotic prophylaxis recommendations endorse first-generation cephalosporins, which often fail to adequately target pathogens most frequently isolated from bile. To date, no specific guidelines for preoperative targeted antibiotic therapy have been established, although tailoring such strategies to the bile microbiome may improve surgical outcomes. This study aimed to characterize bile microbiology in patients undergoing PD for pancreatic ductal adenocarcinoma (PDAC), evaluating potential antibiotherapy regimens that provide effective coverage against the most frequently isolated pathogens. Methods: A retrospective cohort analysis of 725 patients surgically treated for pancreatic tumours at a high-volume pancreatic surgery center between 2017 and 2022 was performed. To minimize heterogeneity, study was restricted to 138 patients who underwent PD with histopathological confirmed PDAC. Intraoperative bile cultures were assessed. Results: Patients with bacteriobilia likewise experienced worse outcomes: higher 5-year mortality (OR 3.01, p = 0.007), greater overall postoperative pancreatic fistula (POPF) occurrence (OR 2.54, p = 0.044) and wound infections (OR 2.90, p = 0.038). Among bile microbiome the highest susceptibility rates were observed for combination of amoxicillin/clavulanic acid with gentamicin, while the lowest were noted for cephalosporin–metronidazole regimen (93.6% vs. 30.2%, respectively). Conclusions: Bacteriobilia contributes to postoperative complications and serves as a predictor of poorer survival after PD. Standard perioperative antibiotic prophylaxis in PD is insufficient. Based on our findings, perioperative antibiotic therapy with amoxicillin/clavulanic acid and gentamicin combination appears to provide superior coverage and may improve postoperative morbidity and overall survival following PD. Full article

Background: Elastic stable intramedullary nailing (ESIN) is widely used in pediatric trauma surgery for benefits such as early limb loading, short hospital stays, and easy implant removal. Perioperative antibiotic prophylaxis (PAP) is used to reduce surgical site infections (SSIs). However, the necessity of PAP in minimally invasive pediatric procedures like ESIN remains unclear. Methods: This retrospective analysis reviewed all pediatric fractures treated with ESIN osteosynthesis at a pediatric trauma center over a time span of 10 years. Focus was set on the use of PAP during implantation and complications in the period between osteosynthesis and implant removal, which was used as follow-up. Results: Between January 2013 and December 2023, a total of 979 ESIN osteosyntheses were performed. In total, 4.1% were lost to follow-up resulting in 939 eligible cases. Complications occurred in 14.7% of all cases. However, complications such as wound healing disorders, wound infections, and osteomyelitis were rare, at 1.7%. Between the different subgroups regarding the application of PAP, type of reduction, openness of the fractures, or localization, no significant differences were found. Conclusions: Besides the most minor complications, ESIN osteosynthesis in children and adolescents is safe treatment. No increased risk for complications was observed when closed reduction was performed without the administration of PAP. Full article

Background/Objectives: Cleft lip and/or palate are common craniofacial anomalies whose surgical repair is classified as clean-contaminated and may be complicated by surgical site infection or palatal fistula. Despite widespread perioperative antibiotic use, there are no standardized, evidence-based recommendations, and rising antimicrobial resistance underlines the need for rational prescribing. This systematic scoping review aimed to map current evidence on prophylactic antibiotic therapy and related perioperative measures in cleft surgery. Methods: A scoping review was conducted using the Arksey and O’Malley framework and reported in line with PRISMA 2020. PubMed, Mendeley and Google Scholar were searched (January 2015–10 February 2025) for English-language retrospective studies, clinical trials, survey studies and systematic reviews concerning prophylactic antibiotics, bone grafting procedures, mouthwash use or oral microbiota in patients undergoing cleft lip and/or palate surgery. Six reviewers independently screened records; two experienced clinicians extracted data on study characteristics, antimicrobial regimens and infectious or microbiological outcomes. Given heterogeneity and the scoping aim, no formal risk-of-bias assessment or meta-analysis was performed. Results: A total of 40 studies met the inclusion criteria, including 21 original research articles. Considerable variation in antibiotic choice, timing and duration was observed, with no clear superiority of any regimen. Single-dose perioperative prophylaxis appeared non-inferior to prolonged courses in several settings. Oral microbiota studies highlighted colonization by resistant and opportunistic pathogens in cleft patients. Conclusions: Current evidence supports individualized, often short-course perioperative antibiotic strategies rather than routine prolonged therapy. High-quality randomized and microbiological studies are required to develop standardized, resistance-conscious guidelines. Full article

Introduction: The appropriate use of antibiotic prophylaxis (AP) in surgical procedures is an ongoing debate. There is a lack of evidence, and urological guidelines provide limited, procedure-specific recommendations. Our aim was to develop a generic model of an audit to define the need for AP in urological procedures, as well as in other surgical specialties. Material and Methods: Based on our experience with the Global Prevalence of Infections in Urology (GPIU) study and a literature review, we defined benchmark standards for 30-day infection rates, including sepsis, and estimated the number of patients needed to be included in a comparative study of AP versus no AP for a surgical procedure within one year. The generic study model was developed during a modified consensus process within the UTISOLVE research group. Urology departments giving and not giving AP were invited to join our development project as an extension of GPIU. Results: Radical prostatectomy was used as a model procedure. Ca. 60 urology centers performing more than 50 radical prostatectomies per year signed up. There was variation in AP practice among sites. Our own review showed that infection rates were ca. 5%, with severe infections, including sepsis, occurring in <0.5% of cases. A sample of 1825 patients would be required to achieve a 95% confidence interval half-width of ±1.0% for general infections. For sepsis, assuming an incidence of 0.5%, a sample of 2124 patients would be needed to reach a 95% confidence interval precision of ±0.30%. Enrollment of 2070 consecutive procedures would be needed to yield precisions of ±0.94% for infection and ±0.30% for sepsis. Based on the number of procedures performed and the number of interested study sites, we agreed on a prospective, multi-center, non-interventional service evaluation, expected to collect standardized data over a 3-month period. The primary outcome was defined as the 30-day incidence of infectious complications. All patients will undergo 30-day post-procedure follow-up through routine clinical care pathways. Conclusions: Our audit model is based on benchmarking of relevant outcomes. It defines how to assess AP in surgical procedures and clarifies a series of issues necessary to defend the status of a generic study model. We regard DEEP-URO to be a comprehensive, multi-center-based initiative that will help balance infection prevention with antimicrobial stewardship and improve the quality of clinical practice and personalized medicine. Full article

Background: Vesicoureteral reflux (VUR) contributes significantly to recurrent childhood urinary tract infections and renal scarring, yet predicting which patients will develop adverse outcomes or benefit from specific investigations or treatments remains challenging. Numerous prognostic tools have been proposed, but none have achieved widespread adoption. Methods: A comprehensive search of the literature available on MEDLINE, PUBMED, Embase, Emcare, CINAHL, and Google Scholar was performed to identify combinations of factors, scoring systems, ratios, models, and tools relating to VUR. This included predicting the spontaneous resolution of established vesicoureteral reflux, the risk of breakthrough urinary tract infections (UTIs), and guiding clinical decision making regarding the need for VCUG in patients with UTIs, continuous antibiotic prophylaxis (CAP), or surgical intervention in patients with confirmed VUR. Articles were included if they either described or validated a predictive tool that was designed to aid clinical decision making in patients with either suspected or confirmed VUR with regards to investigation or management strategies. All the studies included were then analysed, and the predictive tools have been summarised in a narrative format. Results: Seventeen predictive tools developed over thirty-nine years were identified: six predicting spontaneous resolution, four predicting breakthrough urinary tract infection (BTUTI) on CAP, two determining which children benefit from CAP, and five estimating the probability of VUR or high-grade VUR after a first febrile UTI. Approaches ranged from radiological ratios to multifactorial clinical–radiological scores and machine-learning models. Only five tools had any external validation, and none demonstrated sufficient reliability for universal clinical use. Significant heterogeneity in design, imaging interpretation, inclusion criteria, and outcome definitions limited comparison and wider applicability. Conclusions: This atlas provides the first consolidated overview of prognostic tools in paediatric VUR. Future development should prioritise multicentre, prospectively validated models that integrate established clinical and radiological predictors with transparent computational methods to create practical, generalisable risk-stratification frameworks for routine care. Full article

Background/Objectives: In surgical antibiotic prophylaxis (SAP), most studies continue to report the number of prescriptions aggregated at the hospital level, rarely integrating the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classes with standardized volume indicators. This study aimed to evaluate the utilization of antibiotics for SAP in a large Italian teaching hospital using both the number of prescriptions and defined daily doses (DDDs) and mapped the AWaRe models across different surgical specialties to highlight differences relevant to management. Methods: We conducted a prospective hospital-wide surveillance of all consecutive patients undergoing surgical procedures between March and May 2023 at the Azienda Ospedaliero-Universitaria delle Marche. Data included demographics, surgical specialty, and all antibiotic administrations with indication. For SAP, each prescription was classified according to the 2023 WHO AWaRe framework, and consumption was quantified using the WHO ATC/DDD methodology. Results: A total of 914 patients were monitored, with complete antibiotic data for 793 (86.8%). Among 433 SAP prescriptions, the most frequently used agent was cefazolin (82%), followed by amoxicillin/β-lactamase inhibitor (5%) and metronidazole (5%). According to AWaRe, 93% of SAP prescriptions were Access agents and 7% were Watch agents; no Reserve antibiotics were used. When expressed in DDDs (total: 443.5), 87.8% were Access and 12.2% Watch. Cefazolin accounted for over 85% of Access DDDs. Conclusions: By combining AWaRe classes with DDDs and resolving results by surgical specialty, this study extends hospital-level metrics and provides a pragmatic framework for SAP benchmarking. The predominance of Access agents is consistent with management objectives, while differences across specialties identify concrete tools for local quality improvement. Full article