Surgical Prophylaxis

Question 1

Procedural factors to development of SSIs

Answer 1

• Type of surgery
• Length of procedure > 2hr
• Break in sterile technique
• Preop shaving
• Foreign materials

Question 2

Microbial factors to development of SSIs

Answer 2

• Inoculum size
• Tissue adherence
• Virulence factors
• Resistance

Question 3

Patient factors to development of SSIs

Answer 3

• Age
• Immunosuppression
• BMI
• Diabetes
• Smoking status

Question 4

Antimicrobial prophylaxis factors to development of SSIs

Answer 4

• Drug
• Dose
• Delivery time
• Duration
• Appropriate coverage

Question 5

Major pathogens associated with SSIs

Answer 5

• Staph aureus

- CoN staph

Question 6

Indications for surgical prophylaxis

Answer 6

• Clean: indicated in cases of high morbidity/mortality
• Clean/contaminated: Indicated
• Contaminated: indicated
• Dirty: Indicated if therapeutic abx are not broad enough for prophylaxis

Question 7

Which abx require extended infusion times

Answer 7

-Vancomycin
and
-Fluoroquinolone

Question 8

Cefazolin dosing

Answer 8

< 80kg = 1g
80-120kg = 2g
> 120kg = 3g

Question 9

Surgical prophylaxis in pts with beta lactam allergies

Answer 9

a) Clean
- Vancomycin
- Clindamycin 900mg
b) Clean-contaminated
- Clindamycin + Aminoglycoside/FQ/Aztreonam

Question 10

Importance of timing

Answer 10

• Most drugs= 0 to 60 mins before procedure

- Vanco/Fluoroquinolones= 60 to 120 mins before procedure

Question 11

Readministration times

Answer 11

• Cefoxitin q2h
• Cefazolin/cefuroxime q4h
• Cefotetan/Clindamycin q6h

Question 12

When is it appropriate to use Vancomycin

Answer 12

• MRSA documented
• Life threatening beta lactam allergy
• Surgeries involving placement of foreign material

Question 13

Cardiac procedures prophylaxis

Answer 13

• Clean procedures
• Cefazolin 2g x 1
• Add mupirocin if nasal MRSA carrier
• Add vanco if MRSA risk

Question 14

Neurosurgery prophylaxis

Answer 14

• Clean procedure

- Cefazolin 2g x 1 dose

Question 15

Orthopedic procedures prophylaxis

Answer 15

• Clean procedure
• Only needed if:
  
  • Spinal procedure
  • Knee/Hip replacement
• Cefazolin 2g x 1

Question 16

Gastroduodenal procedure prophylaxis

Answer 16

• Recommended only in high risk cases
  
  • Obstruction
  • Perforation
  • Malignancy
  • Acid suppression therapy
• Cefazolin 2g x 1

Question 17

Coloretal procedures and uncomplicated appendectomies

Answer 17

• Clean/contaminated or contaminated
• Cefotetan 2g x 1
• Cefoxitin 2g x 1
• Medications added for ELECTIVE surgery
• Neomycin 1g + erythromycin + Mechanical bowel prep

Question 18

Cesarean Delivery procedure prophylaxis

Answer 18

• Clean or clean/contaminated

- Cefazolin 2g x 1 dose

Question 19

Urologic proceudure prophylaxis

Answer 19

-Clean or clean/contaminated
-Most likely pathogen is E. coli
-Indicated in high risk circumstances
-Cefazolin 2g x 1
plus
-Aminoglycoside (if clean contaminated)