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PHRM 865: Theraputics V > Lecture 17.2: Surgical Prophylaxis > Flashcards

Lecture 17.2: Surgical Prophylaxis Flashcards

Basically Cefazolin

1
Q

What is a Surgical Site Infection?

A
  • Infection Affecting the surgical incision or deep tissue happening up to 30 days after surgery
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2
Q

What is the difference between Prophylactic and Presumptive Antibiotics?

A
  • Prophylactic: PREVENTING development of infection
  • Presumptive: Giving antibiotics when infection isnt proven
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3
Q

What are the different Wound Classifications for surgery?

A
  • Clean
  • Clean-Contaminated
  • Contaminated
  • Dirty
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4
Q

What is the criteria for a “Clean” surgery?

A
  • NO inflammation or cutting into GI, Mouth, GU, Billary, Respiratory
  • NO break in technique

NO ANTIBIOTICS unless high risk

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5
Q

What is the criteria for “Clean-Contaiminated” surgery?

A
  • Controlled opening of GI, Mouth, GU, Billiary, Respiratory with MINOR spills
  • Minor Breaks in Technique

PROPHYLACTIC Antibiotics

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6
Q

What is the criteria for “Contaminated” surgery?

A
  • Non-purulent inflammation present with MAJOR spills
  • MAJOR breaks in technique

PROPHYLACTIC Antibiotics

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7
Q

What is the criteria for “Dirty” Surgery?

A
  • Pre-existing infection present [pus, abscessm necrotic tissues]

THERAPEUTIC antibiotics

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8
Q

What are some of the patient risks for SSI?

A
  • Older
  • Malnutrition
  • DM
  • Smoking
  • Alcohol
  • Has resistant organisms
  • Altered immune response
  • Length in hospital
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9
Q

What are some of the factors that affect the ability of an organism to cause SSI?

A
  • Inoculum
  • Host Defenses
  • Resistant Organisms
  • MRSA
  • Vancomycin
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10
Q

What is the main drug that is used for most, NOT ALL, surgeries?

A
  • Cefazolin 1-2g
  • < 80kg = 1g
  • 80-120kg = 2g
  • > 120kg = 3g
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11
Q

What are the Cardiac Procedures and what is the recommended prophylaxis?

A
  • 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

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12
Q

What are the Thoracic Procedures and what is the recommended prophylaxis?

A
  • NON-CARDIAC [RESPIRATORY] = “CLEAN-CONTAMINATED”
  • S. Aureus
  • Cefazolin, Cefuroxime, Unasyn, Vancomycin [if MRSA], Vancomycin or Clindamycin [if B-lactam allergy]

`

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13
Q

What are the Gastroduodenal Surgeries and what is the recommended prophylaxis?

A
  • 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

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14
Q

What are some fo the Biliary Tract Surgeries and what is the recommended prophylaxis?

Pathogens?

A
  • 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

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15
Q

What is an Appendectomy and what is the recommended prophylaxis?

A
  • 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]
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16
Q

What are some Small Intestine Surgeries and what is the recommended prophylaxis?

A
  • 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
17
Q

What is important to do before a colorectal Surgery and what is the recommended prophylaxis?

A
  • 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

18
Q

What are some important things to note about Gastrointestinal Endoscopy and what is the recommened prophylaxis?

A
  • Prophylaxis for HIGH RISK [prosthetic heart vales, endocarditis..]
  • Amoxicillin or Cefazolin
19
Q

What important to know about Urologic Procedures and what is the recommened prophylaxis?

A
  • GoT: Prevent bacteremia, SSIs
  • E. Coli
  • No Risk: No Prophylaxis
  • Risk Factors: Cirpo or SMX/TMP
  • Cefazolin for Laparoscopic
20
Q

What is the important thing to note about Cesarian Surgery and what is the recommended prophylaxis?

A
  • MOST COMMON SURGERY IN US
  • Bacteroide, Group B Strep
  • Cefazolin
  • B-lactam Allergy: Genta + Metro

+ azithro [non-elective surgery]

21
Q

What is important to know about Hysterectomy and what is the recommened prophylaxis?

-

A
  • 2ND MOST COMMON SURGERY
  • Entercocci, E. Coli, Beteroides
  • Vaginal: Cefazolin
  • Abdominal: Cefoxitin, Cefotetan, Unasyn
  • B-lactam Allergy: Clinda or Vanco + Genta, FQs or Aztreonam
22
Q

What is a Head and Neck surgery and what is the recommended prophylaxis?

A
  • 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

23
Q

What is important to know about Vascular Surgeries and what is the recommended prophylaxis?

A
  • NO Prophylaxis = HIGH Mortality
  • S. Aureus
  • Cefazolin ~24h
  • MRSA?: Vancomycin
  • B-lactam allergy: Clinda or Vanco
24
Q

What is the reasoning that we use prophylaxis antibiotics for Orthopedic Surgeries?

A
  • “Clean” but need prophylaxis for prosthetic
  • Has Bacterial Bioflim
25
Q

For Spinal, Hip, Total Joint Replacements; what is the recommended Prophylaxis?

A
  • Cefazolin
  • MRSA?: Vancomycin
  • B-lactam Allergy: Clinda or Vanco

Mupirocin for if they have colonization

26
Q

What is important to understand for Neurosurgical procedures, and what is the recommended prophylaxis>

A
  • “Clean” with high Mortailty
  • S. Aureus
  • CSF Shunt & Craniotomy: Cefazolin, Cefotaxime
  • MRSA?: Vancomycin
  • B-lactam: Clinda or Vanco

PHRM 865: Theraputics V (42 decks)

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