ANTIMICROBIAL PROPHYLAXIS IN SURGERY

PROPHYLAXIS

“ADMINISTERED BEFORE THE INTENDED SURGICAL PROCEDURE AT THE TIME OF THE INCISION PREVENT BACTERIAL PROLIFERATION .

BACTERICIDAL AND GIVEN INTRAVENOUS.

NEOMYCIN MAY BE USED IN BOWEL PREPARATION FOR COLONIC SURGERY.

ANTIBIOTIC PROPHYLAXIS GUIDELINES A SINGLE PREOPERATIVE DOSE OF

ANTIBIOTIC EFFECTIVE = FIVE DAYS COURSE OF THERAPY ASSUMING UNCOMPLICATED PROCEDURE.

ADMINISTERED WITHIN 1 HOUR INCISION, PREFERABLY WITH INDUCTION OF ANESTHESIA.

TARGET ANTICIPATED ORGANISMS.

CONTD;

NOT BE EXTENDED BEYOND 24 HOURS FOLLOWING SURGERY.

ONE PREOPERATIVE AND TWO OR THREE POSTOPERATIVE DOSES

ARE SUFFICIENT IN CLEAN SURGERY.

CONTAMINATED AND DIRTY PROCEDURES SHOULD ADDITIONALLY

RECEIVE ADDITIONAL POSTOPERATIVE COVERAGE.

DURING PROLONGED PROCEDURES ANTIBIOTIC PROPHYLAXIS

SHOULD BE READMINISTERED EVERY 3 HOURS.

USE OF ANTIBIOTIC IN PROCEDURES CLASSIFIED AS

CONTAMINATED OR INFECTED SHOULD BE USED AS THERAPEUTIC

AND NOT PROPHYLACTIC.

CONTD;IN TRAUMATICALLY INJURED PATIENTS

ANTIBIOTICS CANNOT BE GIVEN BEFORE BACTERIAL CONTAMINATION OCCURS.

CEPHALOSPORINS CEPHAZOLIN 1ST LINE PROPHYLACTIC AGENT MOST SURGICAL PROCEDURES LOW TOXICITY, LONG SERUM HALF LIFE, BROAD SPECTRUM OF ACTIVITY, LOW COST.

THIRD GENERATION NOT BE USED FOR ROUTINE PROPHYLAXIS PROMOTE THE EMERGENCE OF RESISTANCE.

NEUROSURGERY

Neurosurgery Procedure Nosocomial CNS infections not often

occur potentially serious death Narotam, et al divides into 5 catagories :

CleanClean with foreign bodyClean contaminatedContaminatedDirty

Risk Factor ASA classification >2, prolong procedure, post op monitoring (ICP, Ventricular drain, CSF leak)

Organism

Primarily Gram – Positive (S. Aureus) and coagulase negative staphylococcus

Others P. Acnes 5-8% polymicrobial infections

Efficacy Clean procedure antimicrobial

prophylaxis (pediatric, adult) craniotomy + spinal procedure

Studies Cloxacillin / amoxicillin-clavulanate, Clindamycin (β lactam allergic), other low infection rate (5,8 %) compare with no antibiotic prophylaxis

No difference emergency, clean contaminated, dirty procedure, re-operate, operative >> 4 hours)

Choice of Agent Clean Procedure !! Regiments

clindamycin vancomycin, cefotiam, piperacillin, cloxacillin, oxacillin, cefuroxime, cefotaxime, sulfamethoxazole-trimethropim, cefazolin, penicillin-Gamoxicillin-clavulanate

Duration

Recommendations cefazolin Clindamycin or vancomycin (alternative

agent β lactam allergy Single dose 60 minutes before

incision

Efficacy for CSF-Shunting Antimicrobial prophylaxis

recommended Procedures Ventriculostomy, VP-

shunt, Intratechal pump placement, EVD, ICP monitor

DOC cephalosporin i.v Duration single dose prophylaxis

regiment / 24-48 hrs postoperatively

PLASTIC SURGERY

PLASTIC PROCEDURE

Focused reconstructive,dermatological,and cosmetic

Goal primary (restore function), secondary (improving appearance)

Procedures dermatological, breast, head and neck, facial, oral procedure (wedges excision of lip or ear), flaps on the nose, etc

Organism

The Most S. Aureus others Staphylococci and

streptococci Procedures Macerated, Moist

environments,below the waist, pasien with diabetes gram negative (P. aeruginosa,serratia marcescensa,E.coli, klebsiella sp.,P. Mirrabilis)

Efficacy

Doesn’t significantly except nonreconstructive breast cancer procedure

Procedure without implant (-) Procedure with implant (+)

Choice of agent No consensus gram-positive,depending site

of surgery, gram negative (risk factor) Cefazolin or ampicillin-sulbactam most case Clindamycin and vancomycin (alternative) Gram – negative cefazoline (no allergy) or

azteronam, gentamicin, fluoroquinolone (allergy)

Ear antipseudomonal fluoroquinolon Oral cephalexin, amoxicillin,

clindamycin,azithromycin

Duration

Should be limited shortest duration limit advers events + prevent resistance

No significant

Recommendation

No recommended clean procedures Clean-contaminated, breast cancer,

clean-with risk factor cefazoline / ampicillin-sulbactam (single dose), clindamycin/vancomycin (allergic)

PEDIATRIC SURGERY

Background

SSI pediatric >> Organism same as adult MRSA

rarely No studies Recommended DOC as adult,dosage

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