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- 4hrs; - 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

Treatment agents - Quiz 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

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

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 30s 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

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

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 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

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

Surgical Infection Society Resident Corner