Lecture 17.2: Surgical Prophylaxis Flashcards
Basically Cefazolin
What is a Surgical Site Infection?
- Infection Affecting the surgical incision or deep tissue happening up to 30 days after surgery
What is the difference between Prophylactic and Presumptive Antibiotics?
- Prophylactic: PREVENTING development of infection
- Presumptive: Giving antibiotics when infection isnt proven
What are the different Wound Classifications for surgery?
- Clean
- Clean-Contaminated
- Contaminated
- Dirty
What is the criteria for a “Clean” surgery?
- NO inflammation or cutting into GI, Mouth, GU, Billary, Respiratory
- NO break in technique
NO ANTIBIOTICS unless high risk
What is the criteria for “Clean-Contaiminated” surgery?
- Controlled opening of GI, Mouth, GU, Billiary, Respiratory with MINOR spills
- Minor Breaks in Technique
PROPHYLACTIC Antibiotics
What is the criteria for “Contaminated” surgery?
- Non-purulent inflammation present with MAJOR spills
- MAJOR breaks in technique
PROPHYLACTIC Antibiotics
What is the criteria for “Dirty” Surgery?
- Pre-existing infection present [pus, abscessm necrotic tissues]
THERAPEUTIC antibiotics
What are some of the patient risks for SSI?
- Older
- Malnutrition
- DM
- Smoking
- Alcohol
- Has resistant organisms
- Altered immune response
- Length in hospital
What are some of the factors that affect the ability of an organism to cause SSI?
- Inoculum
- Host Defenses
- Resistant Organisms
- MRSA
- Vancomycin
What is the main drug that is used for most, NOT ALL, surgeries?
- Cefazolin 1-2g
- < 80kg = 1g
- 80-120kg = 2g
- > 120kg = 3g
What are the Cardiac Procedures and what is the recommended prophylaxis?
- CABG, Valve Repairs, Placing implateables = “CLEAN”
- Mainly S. Aureus
- Cefazolin, Cefuroxime, Vancomycin [if MRSA], Vancomycin or Clindamycin [if b-lactam allergy
24h duration
Mupirocin nasally to stop colonized MRSA
What are the Thoracic Procedures and what is the recommended prophylaxis?
- NON-CARDIAC [RESPIRATORY] = “CLEAN-CONTAMINATED”
- S. Aureus
- Cefazolin, Cefuroxime, Unasyn, Vancomycin [if MRSA], Vancomycin or Clindamycin [if B-lactam allergy]
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What are the Gastroduodenal Surgeries and what is the recommended prophylaxis?
- Resection of ulcers, Gastric Carcinomas, PEG… - “CLEAN”
- Enterobacterales, Staph, Strep, Oral Anaerboes
- Cefazolin, Vancomycin or Clindamycin + AGs, aztreonam, or FQs [if b-lactam allergy]
Clean because of the stomach acid
What are some fo the Biliary Tract Surgeries and what is the recommended prophylaxis?
Pathogens?
- Cholecystectomy [Bile is noramlly sterile]
- Enterobacterales, Enterococci
- Cefazolin, If b-lactam allergy Vancomycin or Clindamycin + AGs, Aztreonam, FQs [if B-lactam allergy]
- Detect infections during surgery: Cefoxitin, Cefotetan, Unasyn, Ceftriaxone + Metronidazole
Alternatives for Cefazolin = Unasyn, Ceftriaxone, Cefoxitin, Cefotetan
What is an Appendectomy and what is the recommended prophylaxis?
- Dealing with Inflammed Appendix [Uncomplicated]
- E. Coli, B. Fragilis
- Cefoxitin or Cefotetan, Cefazolin + Metronidazole
- if B-lactam Allergy: Metronidazole + Gent, Aztreonam, FQs [C or L]
What are some Small Intestine Surgeries and what is the recommended prophylaxis?
- Anything that deals with the intestines
- E.Coli, Strep, Staph, Entercocci
- WITHOUT obstruction: Cefazolin
- WITH obstruction: Cefoxitin or Cefotetan, Cefazolin + Metro
- B-lactam Allergy: Metro + Genta, Aztre, FQ
What is important to do before a colorectal Surgery and what is the recommended prophylaxis?
- 4L PEG and 90ml Na Phos [One day before to clean you out]
- E. Coli, B. Fragilis
- ORAL: Neomycin + Erytheromycin [after bowel prep]
- IV: Cefoxitin or Cefotetan
- B-lactam allergy: Genta or FQ + Metro
ALT IV: Cefazolin or Ceftriaxone + MEtro
NO CARBAPENEMS
What are some important things to note about Gastrointestinal Endoscopy and what is the recommened prophylaxis?
- Prophylaxis for HIGH RISK [prosthetic heart vales, endocarditis..]
- Amoxicillin or Cefazolin
What important to know about Urologic Procedures and what is the recommened prophylaxis?
- GoT: Prevent bacteremia, SSIs
- E. Coli
- No Risk: No Prophylaxis
- Risk Factors: Cirpo or SMX/TMP
- Cefazolin for Laparoscopic
What is the important thing to note about Cesarian Surgery and what is the recommended prophylaxis?
- MOST COMMON SURGERY IN US
- Bacteroide, Group B Strep
- Cefazolin
- B-lactam Allergy: Genta + Metro
+ azithro [non-elective surgery]
What is important to know about Hysterectomy and what is the recommened prophylaxis?
-
- 2ND MOST COMMON SURGERY
- Entercocci, E. Coli, Beteroides
- Vaginal: Cefazolin
- Abdominal: Cefoxitin, Cefotetan, Unasyn
- B-lactam Allergy: Clinda or Vanco + Genta, FQs or Aztreonam
What is a Head and Neck surgery and what is the recommended prophylaxis?
- Throidectomy, Lymph node remove = “Clean”
- Oral Flora
- Cefazolin or Cefuroxime + Metro; Unasyn
- B-lactam Allergy: Clinda [+AG if Gram (-)]
“Clean-Contaminated” is only when you go THROUGH the mouth
What is important to know about Vascular Surgeries and what is the recommended prophylaxis?
- NO Prophylaxis = HIGH Mortality
- S. Aureus
- Cefazolin ~24h
- MRSA?: Vancomycin
- B-lactam allergy: Clinda or Vanco
What is the reasoning that we use prophylaxis antibiotics for Orthopedic Surgeries?
- “Clean” but need prophylaxis for prosthetic
- Has Bacterial Bioflim
For Spinal, Hip, Total Joint Replacements; what is the recommended Prophylaxis?
- Cefazolin
- MRSA?: Vancomycin
- B-lactam Allergy: Clinda or Vanco
Mupirocin for if they have colonization
What is important to understand for Neurosurgical procedures, and what is the recommended prophylaxis>
- “Clean” with high Mortailty
- S. Aureus
- CSF Shunt & Craniotomy: Cefazolin, Cefotaxime
- MRSA?: Vancomycin
- B-lactam: Clinda or Vanco
