Evidence-Based Surgery (PCS CPGs) Flashcards
Antibiotic prophylaxis for:
Biliary, breast and gastroduodenal surgery
Cefazolin 1g IV single dose
Alt: Cefuroxime 1.5 g IV
Antibiotic prophylaxis for:
Colorectal surgery
- Co-amoxiclav 1.2g IV
- Cefoxitin 2g IV
- Ampi-sul 1.5g IV
Antibiotic prophylaxis for:
CSF shunting
Cloxacillin 1g IV
Alt: Oxacillin 1g IV
Antibiotic prophylaxis for:
Cranial procedures other than CSF shunting
Cefuroxime 1.5g IV
Alt: Cefazolin 1g IV + Genta 80 mg
Antibiotic prophylaxis for:
TCV Surgeries
Cefazolin 1g IV
Antibiotic prophylaxis for:
Orthopedic procedures
Ceftraxone 2g IV
Antibiotic prophylaxis for:
Transurethral resection of the prostrate
Gentamicin 80mg IV within 2 hours before surgery
Antibiotic prophylaxis for:
Elective groin hernia sugery and groin hernia repair
NO prophylaxis recommended!
A TRAP!
in adult patients not undergoing immediate laparotomy, ___ is the imaging modality of choice to determine presence of an intra-abdominal infection.
CT scan
Patient was diagnosed to have a periappendiceal phlegmon. Patient has stable vital signs. Is there room for conservative management, i.e. antimicrobial tx without source control?
HIGHLY selected patients with MINIMAL physiologic derangement and a WELL-CIRCUMSCRIBED focus of infection may be treated conservatively.
Are blood cultures routinely ordered in patients presenting with community-acquired intraabdominal abscess?
NO. They do NOT provide additional clinically relevant information.
Which antibiotic is NOT to be used in the local setting in the management of intraabdominal abscess, due to high resistance rates? Which antibiotics that are traditionally used to cover for anaerobes are NOT recommended locally?
Ampicillin-sulbactam
Aminoglycosides also NOT recommended (too toxic when safer alternatives exist)
NOT recommended anti-anaerobes:
Cefotetan
Clindamycin
What are antibiotics of choice for adult patients with mild to moderate community acquired intraabdominal abscesses?
As single agents: Ticarcillin-clavulanic acid Cefoxitin Ertapenem Moxifloxacin Tigecycline
Combinations of Metronidazole +
Cefax/Cefu/Cefot/Levo/Cipro
For community-acquired infections, do we need to cover for:
- Enterococcus
- Candida
NO!
If the following are isolated in high risk intra-abdominal infections, what is the antibiotic of choice?
- Candida albicans
- Candida albicans in a critically ill patient
- Enterococci
- Fluconazole
- Echinocandins
- Ampi, Pip-Tazo, Vanco
How long is antimicrobial therapy for intraabdominal infections?
4 - 7 days
What is the “recommended imaging procedure for patients with suspected appendicitis”
Helical CT of the abdomen and pelvis with IV (not oral or rectal) contrast
What is the management of a patient with “well-circumscribed periaapendiceal abscess”?
Percutaneous drainage or operative drainage. Appendectomy is DEFERRED.
What is the first imaging technique used for suspected acute cholecystitis or cholangitis?
Ultrasonography
Recommended agennts for uncomplicated acute cholecystitis
Cefazolin 1g IV q8
Cefuroxime 1.5g IV q8
Cefoxitin 2g IV q8
FOXy URO got some AZz.
If allergic, FQ + Metro
Antibiotic of choice for patient with cholangitis
Ciprofloxacin 200mg IV BID
Ceftazidime 1g IV + Ampi 500mg IV QID + Metronidazole 500mg IV
When to give prophylactic antibiotics?
Within 1 hour prior to surgical incision
When to give additional doses of prophylactic antibiotics?
1-2x the half life of the drug
Cefox: 3h
Metro/Cipro: 6h
Preoperative glucose should be <__.
200mg/dL
What is the recommendation re: hair removal prior to surgery?
CLIPPING PRIOR to surgery ONLY if hair interferes with incision
To reduce infection, operative time for colorectal surgery should be less than ____ hr.
3 hours
Treatment of Skin and Soft Tissue Infections
Impetigo / Cutaneous Abscess
Incision and breaking of pus; breaking up of loculations
Treatment of Skin and Soft Tissue Infections
Furuncles (Boils) / Carbuncles
Small furuncles: Moist heat
Large furuncles / All carbuncles: Incision and drainage
NO antibiotics unless with:
- Cellulitis
- Fever
Treatment of Skin and Soft Tissue Infections
Cellulitis / Erysipelas
Penicillin
Roxithromycin is equivalent.
Treatment of Skin and Soft Tissue Infections
MRSA infection
Doxycycline
Clindamycin
TMP-SMX
Rifampin
Always culture lesions and perform susceptibility testing.
Treatment of Skin and Soft Tissue Infections
Necrotizing infections / Fourniere’s gangrene
Surgical debridement!
Do repeat debridement 24 - 36h after initial and daily thereafter.
Antibiotics:
Ampi - aerobic, E. coli, G+
Clinda - anaerobes, aerobic G+ cocci
Metro - enteric G- anaerobes
For Streptococcal TSS:
Clinda + Pen
Treatment of Skin and Soft Tissue Infections
Surgical site infections
Open incision. Evacuate infected material. Change dressing. Let wound heal by secondary intention NO antibiotics!
Treatment of Skin and Soft Tissue Infections
Antibiotic of choice in px with neutropenia with G+ organisms
Vancomycin
Which of the following are accepted routine local maneuvers to prevent catheter-associated UTI? (
A. Daily meatal cleansing with povidone iodine solution
B. Polyantibiotic ointment
C. Green soap or water
D. Catheter irrigation with antimicrobials
NONE of the above!
There are no generally accepted routine local maneuvers.
Recommended site for central venous catheter placement
Subclavian
> Femoral, jugular
Is antibiotics prophylaxis needed for intubated patients requiring tracheostomy
YES!
What is the appropriate timing of tracheostomy in patients on prolonged mechanical ventilation
Within the FIRST WEEK in critically ill adult patients
What signs on physical examination have been documented to be associated with increased perioperative cardiac morbidity and mortality?
S3 heart sound
Neck vein engorgement
Rales
(Signs of CHF)
Which of the following confers the higher cardiac risk?
A. Thoracic surgery
B. Emergency surgery
C. Vascular surgery
D. Abdominal surgery
B and C
