SSI Flashcards
what is the most common pathogen causing SSIs
s. aureus
MRSA screening recommendations
screening and nasal mupirocin decolonization for s aureus colonized patients before total joint replacement and cardiac procedures
vancomycin should not me as prophylaxis to MRSA neg patients
if positive for MRSA
do a preoperative decolonization
2% nasal mupirocin BID for 5days
preoperative dose timing
at a time that serum and tissue conc exceeding MIC for the organism associated with the procedure, at the time of incision ,and for the duration of the procedure
what is the optimal time for administration of pre operative doses
within 60 minutes
agents that require 1-2 hrs administration within 120 minutes ( vancomycin , fluroquinolones)
intra-oprerative -dosing
redosing for all patients is needed to ensure adequate serum and tissue concentrations of the antimicrobial
if duration of the procedure exceeds 2 half lives of the drug
or there’s excess blood loss during the procedure
who is linked to an increased risk for SSI
obesity
cefazolin surgical dosing prophylaxix
-2mg < 120 kg
-3mg >= 120 kg
what is the duration of prophylaxis
the shortest effective duration
- less than 24 hours
– a single does
–48 hours for cardiothoracic procedures
what is the risk of prophylaxis
alter individual and institutional material flors
leading to changes in colonization rates and increase resistance
predispose patients to clostridium difficile associated colitis
criteria for SSI
need at least 1
-purulent incisional drainage
-positive culture of aseptically obtained from superficial wound
-pain, tenderness, swelling, and erythema after incision is open
-diagnosis of SSI by attending surgeon or physician
management of SSI
suture removal plus incision and drainage
adjunctive systemic antimicrobial therapy is NOT indicated
unless associated with a significant systemic response
subcutaneous abscess+ no systemic signs =
incision and drainage
fever in first 48 (up to 4 days)
systemic illness
wound drainage or marked local signs inflammation
gram stain to rule out streptococcus and clostridia
streptococcus and clostridia found in gram stain
open wound, debride
start penicillin ans clindamycin
fever > 4 days after operations
erythema and or induration
—> open wound —> no symptoms
dressing changes, no antibiotics
fever > 4 days after operations
erythema and or induration
—> open wound —> symptoms
begin antibiotics and dressing changes
clean wound, trunk, head, neck, extremity=
start cefazolin or vancomycin until MRSA is rolled out
wound perineum or operation on GI tract or genital tract
start
cephalorsporin + metronidazole
or
levofloxacin + metronidazole
or
carbapenem
cover GN and anaerobes
axilla have significant recovery of
gram negative
perineum have a high incidence of
gram negative and anaerobes
MSRA coverage
vancomycin***
linezolid
daptomycin
telavancin
ceftaroline
made for s. aureus penicillinase
penillinase resistant penicillins
cloxacillin, oxacillin, nafcillin, methicillin
ampicillin/sulbactam
very good for
MSSA
things covered by ampicillin alone
improves activity against gram negative
goodanerobic activity
piper/tazo does not cover
MRSA
VER
MDR gram Neg
elevated MIC
cefazolin and cephalexin
awesome MSSA
Beta strep drug
goof for GN: e.coli, k. pneumoniae, proteus
do not use for s.pneumoniae or enterococcus spp
cefoxitin and cefotetan
only ceps with anaerobic coverage
DOC for intra-ab surgery
increasing b. frag resistance
good MSSA, beta strep
monobactam
aztreonam only one in class
reserve fro the truly allergic patents
