Surgical Prophylaxis Flashcards
what is the superficial incisional SSI?
skin and subcutaneous tissue
what is the deep incisional SSI?
skin, subcutaneous tissue, and deep soft tissue (muscle)
what is the organ/space SSI?
skin subq tissue, deep soft tissue, and organ space
what is the DOC for most procedures?
Cefazolin 2 g IV, OR 3 g for patients >/= 120 kg
when should vanc be used for procedures?
it shouldn’t unless MRSA is at high risk or present. Then use 15 mg/kg IV over 2 hours
what alternatives can be used for surgical prophylaxis?
ciprofloxacin over 2 hours
clindamycin over 1 hour
gentamicin over 1 hour
metronidazole over 1 hour
why would alternative prophylactic agents be used?
patients have life-threatening allergies to first line agents. alternative agents should only be used for patients with an immunologic reaction to a cephalosporin (anaphylaxis)
most common pathogens in MOST procedures?
staph aureus and coagulase-negative staph, and skin flora
most common pathogens in upper GI procedures?
gram negative rods and enterococci and skin flora
most common pathogens in lower GI (colorectal, hysterectomy)?
staph and gram negative rods and enterococci and skin flora, and add anaerobic coverage
most common pathogens ALL TOGETHER?
staph aureus including MRSA, and increased E coli resistance to FQs
when is the best time (best odds) to give antimicrobial prophylaxis for surgery?
preoperative; 0-2 hours before the incision
when is the second best time (second best odds) to give antimicrobial prophylaxis for surgery?
perioperative; within 3 hours after the incision
when should you use repeated dosing?
for procedures that exceed two half-lives of the drug, AND for procedures in which there is excessive blood loss (>1500 mg)
what drugs should be redosed?
cefazolin (every 4 hours after preoperative dose)
clindamycin (every 6 hours after preoperative dose)
what guidelines state that duration of prophylaxis for ALL procedures should be less than 24 hours?
ASHP/IDSA 2013
what guidelines state that antibiotics should be discontinued at the end of incision closure, which is usually 1 dose?
ACS 2016
what guidelines state that the panel recommends against prolongation of surgical antimicrobial prophylaxis after the completion of operation?
WHO 2016
what guidelines state that antimicrobial prophylaxis after surgical closure (clean and clean contaminated procedures) is unnecessary?
HICPAC-CDC 2017
continuation of antimicrobial therapy > 24 hours has been associated with what?
increased risk of C diff and acute kidney injury
how should antibiotics be given for bowel prep?
three doses over 10 hours the afternoon and evening before the operation and after mechanical bowel prep
preparation for elective surgeries looks like this:
isosmotic mechanical bowel prep (PEG day before surgery) from 9 AM to noon, THEN
oral antibiotic prep (completed day before surgery) of neomycin + erythromycin OR neomycin + metronidazole orally at times 1 pm, 2 pm, 11 pm
preferred therapy for cardiothoracic surgery
cefazolin
preferred therapy for GI surgery
cefazolin; add metronidazole to lower GI for anaerobes
preferred therapy for gynecologic and obstetric surgery
cefazolin; add metronidazole for hysterectomy
preferred therapy for head and neck surgery
cefazolin; add metronidazole for clean-contaminated procedures
preferred therapy for orthopedics
cefazolin
preferred therapy for urological surgery
cefazolin; except transrectal prostate biopsy (use ceftriaxone + cipro) and cystourethroscopy (use bactrim)
preferred therapy for other procedures
cefazolin
how can the community pharmacist have a role in prevention of surgical site infections?
smoking cessation (stop 4-6 weeks) use nicotine patches, MRSA screening and decolonization, bowel prep
how can the hospital pharmacist have a role in prevention ofo surgical site infections?
selection, penicillin allergy assessment, dose, timing, intraoperative redosing, duration; GLUCOSE CONTROL (<200)
