Postoperative surgical site infections (SSIs) number approximately 500,000 per year [1] and are the most common nosocomial infection in surgical patients [2]. Contemporary anesthetic practice has a great influence on the prevention of SSIs and other aspects of infectious risk. The purpose of this article is to review concepts involved in prophylaxis against SSI and to discuss aspects of perioperative care in which the anesthetic team may alter the risk of infection and thus influence patient outcomes. Perioperative prophylactic antibiotics Benefits of perioperative antimicrobial prophylaxis need to be balanced against risks. Before the understanding of surgical asepsis and the study and acceptance of the principles of antibiotic prophylaxis, postoperative infections were nearly universal. The benefits of decreased infection rate, length of hospital stay, mortality, and costs have been shown in various populations [2]. The risk of a SSI, however, is dependent on many factors including the surgical procedure, underlying health of the patient, and setting of the procedure (elective or emergent, clean or contaminated, and others). Certain procedures are associated with low risk for a SSI, and the risks of antimicrobial prophylaxis may outweigh the benefits. Risks include allergic reactions, toxic side effects of antimicrobials, adverse interactions with other drugs, and development of resistant organisms. The cost of therapy must also be appreciated; costs include not only the antibiotic itself but also pharmacy charges for preparation, transportation, and administration of multiple doses. In major surgical centers the perioperative use of antibiotics may represent nearly half of the hospital’s expenditure for antibiotics [3]. Although the benefits of prophylactic antibiotics in certain settings have been
