{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:48:10Z","timestamp":1790635690266,"version":"4.1.0"},"reference-count":50,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons\u2019 prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence.<\/jats:p>","DOI":"10.3390\/pathogens14101031","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T08:10:31Z","timestamp":1760343031000},"page":"1031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Optimizing Surgical Antibiotic Prophylaxis in the Era of Antimicrobial Resistance: A Position Paper from the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS)"],"prefix":"10.3390","volume":"14","author":[{"given":"Massimo","family":"Sartelli","sequence":"first","affiliation":[{"name":"Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco M.","family":"Labricciosa","sequence":"additional","affiliation":[{"name":"Global Alliance for Infections in Surgery, 62100 Macerata, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3609-4419","authenticated-orcid":false,"given":"Beatrice","family":"Casini","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3410-9904","authenticated-orcid":false,"given":"Francesco","family":"Cortese","sequence":"additional","affiliation":[{"name":"Emergency Surgery Unit, San Filippo Neri Hospital, 00135 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2815-3119","authenticated-orcid":false,"given":"Monica","family":"Cricca","sequence":"additional","affiliation":[{"name":"Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Facciol\u00e0","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domitilla","family":"Foghetti","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cSanta Croce\u201d Hospital, 61032 Fano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5398-6000","authenticated-orcid":false,"given":"Matteo","family":"Moro","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control Team, IRCCS Ospedale San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Pan","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pasero","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy"},{"name":"Intensive Care Unit, Civil Hospital of Alghero, 07041 Alghero, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-4877","authenticated-orcid":false,"given":"Giuseppe","family":"Pipitone","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, ARNAS Civico-Di Cristina, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9953-7769","authenticated-orcid":false,"given":"Giancarlo","family":"Ripabelli","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences \u201cVincenzo Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sartelli, M., Boermeester, M.A., Cainzos, M., Coccolini, F., de Jonge, S.W., Rasa, K., Dellinger, E.P., McNamara, D.A., Fry, D.E., and Cui, Y. 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