Abstract
Background. Surgical interventions are accompanied by the risk of developing surgical site infections (SSIs), which significantly increase morbidity, mortality, and healthcare costs. Perioperative prophylaxis and antimicrobial therapy are key components of the prevention and treatment of infectious complications, but their inappropriate use contributes to the formation of antimicrobial resistance (AMR) - one of the global threats of our time. Optimization of the use of antimicrobial drugs in surgery requires the integration of the principles of antimicrobial stewardship programs (ASP) and interdisciplinary cooperation. Aim: to assess current problems of perioperative prophylaxis and antimicrobial therapy in surgery with an emphasis on compliance with recommendations, the impact on the development of ABR and the prospects for the implementation of ASP. Materials and methods. Analysis of data presented in PubMed, using the keywords "perioperative prophylaxis", "antimicrobial therapy", "surgery". The search strategy was developed in accordance with PRISMA 2020 guidelines to ensure a comprehensive and transparent approach. Results. It was found that compliance with international recommendations for perioperative prophylaxis (antibiotic administration 30-60 min before the incision, duration of prophylaxis ≤24 h) is associated with a decrease in the frequency of SSIs. Prolonged or inappropriate antibiotic use increases the risk of ADR, Clostridioides difficile infections, toxic complications, and hospital-acquired superinfections. Significant variability in the practice of prescribing perioperative prophylaxis among surgeons, insufficient awareness of international guidelines, and low level of interaction with ASP teams were found. At the same time, the implementation of ASP, regular microbiological monitoring, the use of biomarkers (in particular, procalcitonin), educational interventions, and a multidisciplinary approach have proven effective in reducing unjustified antibiotic prescription and improving treatment outcomes. Conclusion. Perioperative prophylaxis and antimicrobial therapy remain fundamental components of the prevention and treatment of infectious complications in surgery. Non-compliance with recommendations significantly increases the risk of SSIs and forms antimicrobial resistance. To reduce this burden, the implementation of ASP, standardization of perioperative prophylaxis protocols, and increased awareness among surgeons are necessary. The use of new technologies, including artificial intelligence, for predicting AMR and personalizing antimicrobial therapy is promising