Therapeutics ID Maynard Flashcard

Patient Associated Risk Factors for Surgical Infections

  • Age
  • Mulnutrition
  • Obesity
  • DM
  • Smoking
  • Coexisting Infections
  • Bacterial Colonization
  • Immunosuppression
  • Prolonged Post-Op Stay

Operation Associated Risk Factors for Surgical Infections

  • Length of surgical scrub
  • Skin antisepsis
  • Preoperative shaving
  • Preoperative skin prep
  • Length of operation
  • Antimicrobial prophylaxis
  • Operating theatre ventilation
  • Inadequate instrument sterilization
  • Foreign material in surgical site
  • Surgical drains
  • Surgical technique
  • Post Op Hypothermia

Major Pathogens Associated with Surgical Site Infections

  • Staph. aureus
  • Coagulase-Negative Staph
  • Enterococcus
  • Escherichia coli
  • Pseudomonas aeruginosa

Resistance associated with:

  • Hospital personnel transmission
  • Broad-spectrum antibiotic use
  • Extended duration of antibiotic use
  • Possible increase with prophylaxis

Class of antibiotcs not recommended for treating surgical site infections

3rd Generation Cephalosporins

  • Less G+ activity
  • Poor anaerobic activity
  • Other unnecessary coverage (organisms not encountered in surgical procedures)
  • Increased cost

Pathogens associated with Colorectal Surgery

Enteric G- bacilli

Anaerobes

Enterococci

Prophylactic Antibiotics for Colorectal surgery

PO:

Neomycin + Erythromycin or Metronidazole

 

IV:

Cefotetan or Cefoxitin

Prophylactic Antibiotics for Appendectomy

IV:

Cefotetan or Cefoxitin

Pathogens associated with Appendectomy

Enteric G- bacilli

Anaerobes

Enterococci

 

Pathogens associated with Cariothoracic Surgery

Staph. aureus

Staph. epidermidis

Prophylactic Antibiotics for Cardiothoracic Surgery

Cefazolin

 

Alt:

Cefuroxime

Vancomycin

Pathogens Associated with Vascular Surgery

Staph. aureus

Staph. epidermidis

G- bacilli

Prophylactic Antibiotics for vascular surgery

Cefazolin

 

Alt:

 

Vancomycin + Ciprofloxacin OR gentamicin OR Aztreonam (if G- is a large concern, ie, groin incisions)

Pathogens associated with Orthopedic Surgery

Staph. aureus

Staph. epidermidis

Prophylactic Antibiotics for Orthopedic Surgery

Cefazolin

 

Alt:

 

Vancomycin

Initial dosing for most antibiotics
Given after anesthesia and procedure is started within 15 minutes
Initial dosing for Vancomycin

Initiate infusion 1-2 hrs prior to incision

 

Need time for drug to get to tissues — poor penetration into tissues

Infusing vanco too fast would cause “red man syndrome”

When do you redose for antibiotic prophylaxis?

General rule is you redose 1-2 x the half life of the drug

  • If surgery is longer than 4 hours
  • If there is major blood loss

 

What is the duration of prophylactic antibiotic therapy?

  • Only the single pre-op dose is necessary
  • NO more than 24 hrs post-op

Non-Pharmacological Treatment

  • Normothermia
  • Aggressive Glucose Control
  • Fluid Resuscitation

Supplemental O2 is debatable

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