Antibiotics in SA Surgery

Question 1

common issues caused by surgical site infections - how common are they

Answer 1

SSIs are a common cause of post- operative morbidity, therapeutic intervention and prolonged hospital stay

Overall rate in small animal surgery - 5.5%

Question 2

what categories of factors increase risk of SSI

Answer 2

-Patient Factors
-Pre-operative Factors
-Intra-operative
-Post-operative

Question 3

patient factors that increase risk of SSI/indicate abx

Answer 3

-Age (>8yrs)
-Pre-existing metabolic disease
-Prior radiation of the surgical site
-High body condition score
-Colonization with MRSP?

Question 4

Pre-operative Factors that increase risk of SSI/indicate abx

Answer 4

-Propofol administration
-Clipping prior to induction
-Inadequate skin prep
-Inadequate surgeon hand prep
-Duration of anesthesia

Question 5

Intra-operative Factors that increase risk of SSI/indicate abx

Answer 5

-Duration of surgery
-Foreign material
-Multifilament suture
-Electrocautery
-# of people in OR
-Contamination defined by type of surgery and infective dose of bacteria
-Glove perforation

Question 6

how common are glove perforations?

Answer 6

– ~26% of procedures have at least one glove perforation
– Emphasizes importance of presurgical hand asepsis!

Question 7

Alcohol rub vs Scrub brushes

Answer 7

-Rapid action
-Less skin irritation
-Waterless
-No risk of recontamination
-WHO standard
-Sustained effect
-$$$$
-1.5 min

Question 8

what is a clean surgery and do we need prophylaxis for this

Answer 8

• No break in aseptic technique
• GI, GU, respiratory, oro-pharyngeal tracts not entered
• Prophylaxis generally not needed unless… Controversial subject!

Question 9

what is a clean-contaminated surgery and do we need prophylaxis for this

Answer 9

• GI, GU, and respiratory tracts entered under controlled conditions
• Clean wounds in which drain placed
• Prophylaxis indicated

Question 10

what is a contaminated surgery and do we need prophylaxis for this

Answer 10

• Visibly inflamed tissue associated with trauma
• GI contents or infected urine spilled
• Prophylaxis and therapeutic indicated

Question 11

what is a dirty surgery and do we need prophylaxis for this

Answer 11

• Ruptured GI tract prior to surgery
• Foreign material or pus in wound
• Prophylaxis and therapeutic indicated

Question 12

Timing of Prophylactic ABX

Answer 12

-Must be administered PRIOR to contamination 30-60 min before skin incision
-In longer procedures should be administered every 90 minutes or 1-2 T 1⁄2 lives of the drug
-Prophylactic ABX should be discontinued after surgery

Question 13

how do we decide what abx to use prophylactically

Answer 13

Knowledge of normal flora essential for making “best guess” of bacteria to be encountered

Question 14

Parenteral vs Topical Administration; what is preferred for prophylactics

Answer 14

Parenteral - results in drug within the circulatory system
***Preferred route

Topical - no benefits over parenteral
>May not reach bacteria in blood clots
>Cytotoxic and can effect wound healing

Question 15

Complications of ABX Prophylaxis

Answer 15

Diarrhea
Vomiting
Anaphylactic / Allergic reaction
Hypotension?
Super-infection
Selection of multi drug resistant (MDR) -resistant bacteria

Question 16

Rules of ABX Prophylaxis

Answer 16

-ABX COMPLEMENT meticulous surgical technique
-Determine the risk of infection and if benefit of prophylactic ABX outweighs the potential risk
-Use a narrow spectrum ABX to preserve the patients own flora
>***Avoid “BIG GUN” for prophylaxis
-Maintain ABX for only as long as risk of contamination is present