Surgical Prophylaxis Flashcards
Patients receiving therapeutic antimicrobials do not require doses for surgical ppx (T/F)
False
Surgical ppx situations where preferred regimen is NOT single dose of cefazolin pre-op
Appendectomy: cefoxitin/cefotetan/cefazolin+flatly
Small intestine with obstruction: cefoxitin/cefotetan/cefazolin+flatly
Colorectal: cefoxitin/cefotetan/cefazolin+flagyl/amp-sulbactam/CTX+flagyl/ertapenem
Ophthalmic: topical polytrim or FQ
Lower tract urologic procedures: FQ/TMP-SMX/cefazolin
Urologic clean-contaminated: cefazolin+flagyl/cefoxitin
Liver transplant: pip-tazo/CTX+ampicillin
Definition of clean surgical procedure
Clean: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered.
Definition of clean-contaminated surgical procedure
Clean-contaminated: Operative wounds in which the respiratory, alimentary, genital, or uri- nary tracts are entered under controlled condi- tions and without unusual contamination
Definition of contaminated surgical procedure
Contaminated: Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the gastrointes- tinal tract
Definition of superficial incisional SSI
Superficial incisional SSI: Occurs within 30 days postoperatively and involves skin or sub- cutaneous tissue of the incision and at least one of the following: (1) purulent drainage from the superficial incision, (2) organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision, (3) at least one of the following signs or symptoms of infection:
Definition of deep incisional SSI
Deep incisional SSI: Occurs within 30 days after the operative procedure if no implant is left in place or within one year if implant is in place and the infection appears to be related to the operative procedure, involves deep soft tissues (e.g., fascial and muscle layers) of the incision, and the patient has at least one of the following: (1) purulent drainage from the deep incision but not from the organ/space component of the surgical site, (2) a deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured
Definition of organ space SSI
Organ/space SSI: Involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure
Optimal timing of surgical ppx
The optimal time for administration of preoperative doses is within 60 min- utes before surgical incision
Some agents, such as fluoro- quinolones and vancomycin, require administration over one to two hours; therefore, the administration of these agents should begin within 120 minutes before surgical incision.
Intraoperative redosing in surgical prophylaxis
For all patients, intraoperative redosing is needed to ensure adequate serum and tissue concentrations of the antimicrobial if the duration of the procedure exceeds two half-lives of the drug or there is excessive blood loss during the procedure
redosing interval should be mea- sured from the time of administration of the preoperative dose, not from the beginning of the procedure.
Redosing intervals:
None: vancomycin, FQs, metronidazole, ertapenem
2h: penicillins
4h: cephalosporins
Surgical ppx in patients receiving therapeutic antimicrobials
Patients receiving therapeutic antimicrobials for a remote infection before surgery should also be given antimicrobial prophylaxis before surgery to ensure adequate serum and tissue levels of antimicrobials with activity against likely pathogens for the duration of the operation.
If the agents used therapeutically are appropriate for surgical prophylaxis, administering an extra dose within 60 minutes before surgical incision is sufficient.
Role of topical agents in (non-colorectal) surgical ppx
Limited high-quality data are available re- garding the use of antimicrobial irrigations, pastes, and washes that are administered topically and topi- cal administration does not increase the efficacy of parenteral antimicro- bials when used in combination for prophylaxis.
Role of mupirocin in surgical ppx
Most studies conclude that the use of preoperative intranasal mupirocin in colonized patients is safe and po- tentially beneficial as an adjuvant to i.v. antimicrobial prophylaxis to decrease the occurrence of SSIs. However, the optimal timing and duration of administration are not standardized
