Surgical Infection Society Resident Corner Surgical Infections Prophylaxis

Surgical Site Infection (SSI) • Account for 14 -16% of all hosp-acquired infections •

Key points in Preventing Surgical Infections Antibiotic prophylaxis • Drugs- which when, how many

Principles of Surgical Prophylaxis • Antibiotic stewardship is essential – narrow the agent used

Surgical Prophylaxis Cefazolin • Half - 2 hr • 1 -2 gr pre-op, •

If patient is allergic to Penicillin Should always try to assess degree of allergy

Surgical Infections Treatment agents - Quiz

Which one of the following are/is characteristic of Tetracyclines • A. Bactericidal • B.

Tetracyclines • Active against many gram negative and most gram positive organisms • Alters

Which one of the following are/is characteristic of Aminoglycosides • A. Active against a

Aminoglycosides • Aminoglycosides bind to the 30 s ribosomal subunit • They interfere with

Inhibits cell wall synthesis • • • A. Amphotericin B B. Penicillin C. Cephalosporins

Impairment of bacterial DNA synthesis • • • A. Amphotericin B B. Penicillin C.

Disruption of membrane barrier function • • • A. Amphotericin B B. Penicillin C.

Disruption of ribosomal protein synthesis • • • A. Amphotericin B B. Penicillin C.

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Surgical Infection Society Resident Corner

Surgical Infections Prophylaxis

Surgical Site Infection (SSI) • Account for 14 -16% of all hosp-acquired infections • 2 -5% of all surgical patients will develop SSI – Thus between 1 to 2 million SSI’s occur annually in the U. S. • SSI increases LOS in hospital – average 7. 5 days • Excess cost per SSI: – *US national costs: $130 -845 million/year

Key points in Preventing Surgical Infections Antibiotic prophylaxis • Drugs- which when, how many doses? Non antibiotic measures- evidence based • Hair removal • Normothermia • Oxygen supplementation • Normoglycemia

Principles of Surgical Prophylaxis • Antibiotic stewardship is essential – narrow the agent used as much as possible. • What are the most likely organisms in the operative field? • It is essential to know drug half-life. – Re-dose in long cases that extend across half-lives – Or in cases with considerable blood loss – sterilizing the floor” • • Drug should be given within 1 hour of incision But time should be allowed for antibiotic to circulate Single pre-op dose is adequate for most cases Caution must be exercised against the potential side effects of the agent choosen (eg C. Diff colitis or nephrotoxicity) • Remember potential antibiotic exposure from prior hospitalization(s)

Surgical Prophylaxis Cefazolin • Half - 2 hr • 1 -2 gr pre-op, • Should be re-dosed if case goes longer than 4 hours Cefotetan or cefoxitin • Good for colonic cases, or involving anaerobes • Half-life - Cefotetan- 4 hrs; - cefoxitin- 1 hr

If patient is allergic to Penicillin Should always try to assess degree of allergy – Nausea is not an allergy If allergic – options include • Vancomycin – need to exercise with rapidly shifting vascular volumes – Vancomycin I gr IV – Should be started 1 hr pre-operatively, slow infusion (to avoid red man syndrome) – usually over a period of one hour infusion • Clindamycin – Very highly associated with C. Diff • For colonic cases - clindamycin or metronidazole combos

Surgical Infections Treatment agents - Quiz

Which one of the following are/is characteristic of Tetracyclines • A. Bactericidal • B. activity against Mycobacterium tuberculosis • C. Discoloration of teeth • D. Risk of Superinfection • E. Narrow spectrum

Tetracyclines • Active against many gram negative and most gram positive organisms • Alters ribosomal protein synthesis • It is bacteriostatic

Which one of the following are/is characteristic of Aminoglycosides • A. Active against a broad spectrum of Gram negative Aerobes • B. Emergence of Resistant bacterial strains does not occur • C. narrow margin between therapeutic and toxic levels • D. nephrotoxicity • E. Ototoxicity

Aminoglycosides • Aminoglycosides bind to the 30 s ribosomal subunit • They interfere with the proof-reading step • Disrupt the integrity of the bacterial cell membrane • Aminoglycosides are useful primarily in infections involving aerobic, Gram-negative bacteria, such as Pseudomonas, Acinetobacter, and Enterobactere

Inhibits cell wall synthesis • • • A. Amphotericin B B. Penicillin C. Cephalosporins D. Aminoglycosides E. Quinolones

Impairment of bacterial DNA synthesis • • • A. Amphotericin B B. Penicillin C. Cephalosporins D. Aminoglycosides E. Quinolones

Disruption of membrane barrier function • • • A. Amphotericin B B. Penicillin C. Cephalosporins D. Aminoglycosides E. Quinolones

Disruption of ribosomal protein synthesis • • • A. Amphotericin B B. Penicillin C. Cephalosporins D. Aminoglycosides E. Quinolones

Surgical Infection Society Resident Corner