Recommendation Grading
Strength of Evidence and Grading Recommendation
Level I
Evidence from large, well-conducted randomized, controlled clinical trials
or a meta-analysis
Level II
Evidence from small, well-conducted randomized, controlled clinical trials
Level III
Evidence from well-conducted cohort studies
Level IV
Evidence from well-conducted case–control studies
Level V
Evidence from uncontrolled studies that were not well conducted
Level VI
Conflicting evidence that tends to favor the recommendation
Level VII
Expert opinion or data extrapolated from evidence for general principles
and/or other procedures
Category A Levels I-III
Category B
Levels IV-VI
Category C Level VII
Abbreviations
hrs, hours; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillinsensitive S. aureus; NHSN, National Healthcare Safety Network; SSI, surgical site
infection
Source
Bratzler DW, Dellinger EP, Olsen KM, Perl T, Auwaerter PG, Bolon MK, Fish DN,
Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical Practice
Guidelines for Antimicrobial Prophylaxis in Surgery. Am J Health Syst Pharm. 2013
Feb 1;70(3):195-283.
Disclaimer
The recommendations in these guidelines may not be appropriate for use in all clinical
situations. Decisions to follow these recommendations must be based on the judgment of the
clinician and consideration of individual patient circumstances and available resources. These
guidelines reflect current knowledge (at the time of publication) of antimicrobial prophylaxis
in surgery. Given the dynamic nature of scientific information and technology, periodic review,
updating, and revisions are to be expected.
This Guideline attempts to define principles of practice that should produce high-quality patient
care. It is applicable to specialists, primary care, and providers at all levels. This Guideline
should not be considered exclusive of other methods of care reasonably directed at obtaining the
same results. The ultimate judgment concerning the propriety of any course of conduct must be
made by the clinician after consideration of each individual patient situation.
Neither IGC, the medical associations, nor the authors endorse any product or service associated
with the distributor of this clinical reference tool.
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