Surgical Prophylaxis

Question 1

Surgical Site Infection, Clinical Presentation

Answer 1

-Within 30 days post-op or 90 days if prosthetic device
-At surgical incision site/organ
-Purulent drainage
-Positive fluid culture
-Redness, pain, cloudy, fever, elevated WBC

Question 2

Antiseptic Prophylaxis

Answer 2

Pre-Operative Bathing or Showering
- CDC: shower or bathe (full body) with soap (antimicrobial or non-antimicrobial) or an antiseptic agent on at least the night before the operative day
- Rationale: Reduces skin microflora

Perform intraoperative skin preparation with an alcohol-based antiseptic agent unless contraindicated

Question 3

Common pathogens in SSI

Answer 3

-Staph aureus
-E coli
-Staph neg coag
-Enterococcus
-Pseudomonas
-Klebsiella

SPEEKS

Question 4

Screening and Decolonization

Answer 4

Pre-operative intra-nasal mupirocin 2% ointment (Bactroban) is safe and beneficial as adjunct therapy to IV antibiotics

− Strongest data in cardiac and orthopedic patients
− Surveillance of S.aureus susceptibility to mupirocin is advised

Screen for S. aureus and decolonize surgical patients with an anti-staphylococcal agent in the preoperative setting for high- risk procedures

Question 5

Choice of Antibiotics

Answer 5

“For most procedures, cefazolin is the drug of choice for prophylaxis because it is the most widely studied antimicrobial agent, with proven efficacy. It has a desirable duration of action, spectrum of activity against organisms commonly encountered in surgery, reasonable safety, and low cost.”

Question 6

Allergy to beta-lactams:

Answer 6

Vancomycin as alternative if life-threatening allergy to cefazolin

Question 6

Pre-Operative Antibiotic Timing

Answer 6

-IV is ideal
-Within 60 minutes prior
-If infusion is 1 hour long, infuse at 120 min before
-Shorter infusion times, 30 min prior may be OK

Question 7

In children >40 kg:

Answer 7

use adult dosing if weight-based dosing > adult dosing

Question 8

Intraoperative Redosing

Answer 8

Required if duration of procedure > 2 half lives of a drug OR excessive blood loss during procedure
-also burn patients (ex)

Question 9

Oral antibiotics usually for:

Answer 9

-colorectal surgery prophylaxis
-conjunction with bowel prep

Question 10

Other Agents Besides Cefazolin:

Answer 10

-Cardiac/Thoracic: cefuroxime

-Abd: all the CEFs, amp/sul, metro with cefazolin

-Colorectal: cefotetan, amp/sul, cefa/metro, ertapenem

-Plastic: amp/sul

-Urologic: cefa +/- AG/metro or cefoxitin

Question 11

Duration of Post-Operative Antibiotics

Answer 11

− For most procedures, < 24 h is recommended
− For many procedures, no doses needed after incision closure