-
infective endocarditis has mostly what kind of bugs?
- G positive (staph, strep, enterococcus)
- sticky bugs that sit on heart valves
- rarely GN unless immunocompromised
-
ppx is not really helpful for IE. when do you ppx?
- high risk:
- prosthetic cardiac valve or prosthetic material used for cardiac valve repair
- previous IE
- congenital heart disease
- cardiac transplant pts who develop cardiac valvulopathy
-
ppx?
dental procedures that involve manipulation of gingival tissue
yes
-
ppx?
dental procedures that involve manipulation of periapical region of teeth
yes
-
ppx?
dental procedures that involve perforation of oral mucosa
yes
-
ppx?
routine anesthetic injections through noninfected tissue
nope
-
ppx?
dental radiograph
nope
-
ppx?
placement of removable prosthodontic or orthodontic appliances
nope
-
ppx?
adjustment of orthodontic appliances
nope
-
ppx?
shedding of deciduous teeth
nope
-
ppx?
placement of orthodontic brackets
nope
-
ppx?
bleeding from trauma to the lips or oral mucosa
nope
-
for dental, ___ spectrum abx is used, single dose 30-60min before procedure.
narrow
-
if pt can take PO, what abx used for dental procedure?
amoxicillin 2g adult
-
if pt cannot take PO for dental procedure, what abx used?
- ampicillin 2g iv/im
- or
- cefazolin or ceftriaxone 1g iv/im
-
if pt is allergic to pcn or ampicillin but still can take PO, what to give for dental procedure abx?
- cephalexin 2g
- clindamycin 600mg
- or azithromycin or clarithromycin 500mg
-
if pt is allergic to pcn or amp and cannot take PO, what to give for dental procedure ppx?
- cefazolin or ceftriaxone 1g im/iv
- or clindamycin 600mg im/iv
-
ppx for respiratory T&A (tonsillectomy and adenoidectomy)?
-
ppx for respiratory incision or biopsy of respiratory mucosa?
-
ppx for respiratory drainage of an abscess or empyema?
-
ppx for respiratory bronchoscopy?
not required unless procedures involves incision of the resp tract mucosa
-
ppx for GI/GU?
- not recommended
- mostly GN bugs
-
ppx for esophagogastroduodenoscopy or colonoscopy?
- nope
- GI/GU usually not recomm
-
ppx for transrectal GI/GU procedure?
- yes
- the only time when abx needed for GI/GU procedure
-
ppx for urethral procedure?
- not normally b/c urine is sterile and we don't treat colonization
- but if colonization in urine for prostate biopsy, then consider cipro for abx
-
which abx cover for enterococci?
-
abx if infected skin or musculoskeletal and pt on long term abx therapy?
- keep on abx
- (high risk)
- slide 9
-
ppx if established infxn of GI/GU?
yes
-
ppx for elective cystoscopy or urinary tract manipulation with infection or colonization?
yes
-
ppx for heart valves or prosthetic intravascular or intracardiac materials?
yes
-
ppx for stents or CABG?
nope not necessary
-
most common complications of surgery?
- surgical site infection (SSI) - very high
- sepsis
- CV
- respiratory
- thromboembolic (esp b/c pt are bedridden; need DVT ppx)
-
risk factors of surgical site infection?
- extremes of age (too young, too old)
- undernutrition
- obesity (gastrobypass is a high risk for obese pt)
- diabetes
- hypoxemia
- remote infxn
- corticosteroid tx (concern in COPD)
- recent operation
- chronic inflamm
- prior site irradiation
-
for surgical ppx optimal agent is narrow spectrum abx. so what abx should you avoid?
- carbapenem
- cipro
- these are broad spectrum
-
guideline for appropriate abx ppx for surgery?
- low tox and safe
- not routinely used for tx of serious infxn
- abx that includes causative agent
- adequate conc in relevant tissue
- admin for short period
- timely admin to ensure abx in surgical site during incision
-
primarily closed
A) clean
-
elective procedure involving no acute inflammation
D) clean
-
no break in technique
D) clean
-
no transection of GI, oropharyngeal, GU, bilirary, or tracheobroncial tract
A) clean
-
biopsy of breast
C) clean
-
procedures involving transection of GI, oropharyngeal, GU, biliary, trancheobronchial tracts with minimal spillage
D) clean contaminated
-
minor breaks in technique
D) clean contaminated
-
clean procedures performed emergently
C) clean contaminated
-
clean procedures with major breaks in technique
D) clean-contaminated
-
reoperation of clean surgery within 7 days
a) clean
b) clean-contaminated
c) contaminated
d) dirty
clean contaminated
-
procedures following blunt trauma
D) clean contaminated
-
clean contaminated procedures during which acute, non-prulent inflamm is encountered
D) contaminated
-
procedures performed within 4 hr of penetrating trauma or involving a chronic open wound
B) contaminated
-
clean contaminated procedures during which major spillage or technique break occurs
C) contaminated
-
procedures performed when there is obvious pre-existing infection (abscess, pus, necrotic tissue present)
D) dirty
-
pre-operative performation of GI, oropharyngeal, biliary or tracheobronchial tracts
B) dirty
-
penetrating trauma greater than 4 hrs old
D) dirty
-
which two do not receive ppx abx but TREATMENT for preseumed infxn?
a) clean
b) clean-contaminated
c) contaminated
d) dirty
-
diabetes with cellulitis who needs debridement
D) contaminated
-
ppx?
clean contaminated
yes
-
ppx?
any procedure in which post-operative infxn, however unlikely, may have severe consequences
yes
-
ppx?
breat procedures and hernia procedures
yes but questionable
-
-
ppx?
GI, head/neck, neurosurgical, OBGYN, orthopedic, urologic, vascular, implantation of prosthetic material
yes (slide 22)
-
SCIP says, parenteral abx ppx should be started within ___h before incision. if vanco or FQ, start within __h.
-
SIP says, ppx abx should be d/c'd within ___h after surgery end time.
24h
-
if procedure is >4h or major blood loss occurs, abx should be re-dosed q _____.
1-2 half lives.
-
what happens if unnecessary abx?
c.dif
-
infection rates are lower if duration of ppx is longer. T or F?
- F!!
- infxn rates are the same regardless of duration of ppx (slide 27)
-
prolonged ppx decreses the flora and lower infection rate. T or F
- F!
- prolonged ppx only changes the flora and does NOT lower infectino rate.
-
according to SCIP, how do you prevent infxn for cardiac surgery pt specifically?
- blood glucose control
- (slide 31)
-
according to SCIP, how d you prevent infxn for colorectal surgery specifically?
normothermia
-
according to SCIP, should you remove hair to prevent infxn?
- nope
- proper hair removal with clipper or no removal at all
-
4 things to prevent during/after surgery according to SCIP?
- prevent infection
- prevent VTE
- prevent cardiac event
- prevenet respiratory complication
-
SCIP: to prevent VTE during surgery, appropriate VTE ppx should be administered within ___h before or after surgery.
24h
-
SCIP: how do you prevent cardiac events?
if pt receiving b-block before arrival, give peri-operative b-blockers
-
SCIP: how to prevent repiratory complication?
- if mechanical vent
- 1) elevate head 30o
- 2) stress ulcer dz ppx
- 3) standard weaning protocol
-
3 organisms in abdominal or vaginal hysterectomy?
- enteric GN bacilli
- Gp B strep (could cause endocarditis)
- enterococci
-
what is preferred and alt ppx abx for abdominal or vaginal hysterectomy?
- preferred: cefotetan (cephamycin)
- cefazolin, cefoxitin, cefuroxime
- (Unasyn can be used but reserved for TX b/c only one that can cover enterococci)
-
what is ppx abx for abdominal or vaginal hysterectomy, if b-lactam allergy?
- clinda + gent/cipro/aztreonam (GN cover)
- metro + gent/cipro
- clinda mono
- tinidazole 2g single PO 4-12h before surgery
- levo 750mg
-
reason for ppx in cesarean section?
after cord clamping, to reduce exposure to infant
-
what is ppx abx for cesarean section?
cefazolin 1-2g
-
what is ppx abx for cesarean section, if pcn allergy?
clinda + gent/cipro/levo/aztreonam
-
new recommendation suggests abx within __ h prior to cesarean section.
1 h
-
for abortion surgery, what is ppx abx for 1st trimester?
- pen G 2mu IV
- or doxycycline 300mg po
-
for abortion surgery, what is ppx abx for 2nd trimester?
cefazolin 1-2g IV
-
2 prevalent organisms for hip or knee arthroplasty?
-
hip or knee arthroplasty
-
if a tourniquet is used in the procedure, do you need abx for hip or knee arthroplasty? how long?
- yes
- entire dose of abx must be infused before the inflation
- may continue for 24h
-
what ppx for hip or knee arthroplasty?
cefazolin or cefuroxime
-
what ppx for hip or knee arthroplasty if b-lactam allergy?
-
what ppx for hip or knee arthroplasty if high risk for MRSA?
vanco
-
what ppx to use for open reduction of closed fracture with interal fixation?
- ceftriaxone 2g IV (broad coverage)
- this is clean-contaminated
-
ppx?
cardiac surgery putting electrophysiologic device
yes
-
ppx?
ventricular assist device
- yes
- cardiac surgery
- (slide 41)
-
ppx?
ventriculoatrial shunts
- yes
- cardiac surgery
- (slide 41)
-
ppx?
arterial patches
- yes
- cardiac surgery (slide 41)
-
ppx?
permanent pacemakers
- yes
- cardiac surgery (slide 41)
-
2 organisms involved during cardiothoracic and vascular surgery?
-
ppx for cardiothoracic and vascular surgery can continue for ___ h.
72 h (3 days)
-
do you need to continue abx ppx for cardiothoracic and vascular surgery until chest or mediastinal drainage tubes are removed?
-
abx for cardiothoracic and vascular surgery can prevent what 2 things?
- mediastinitis
- sternal wound infxn
- (slide 42)
-
open reduction of closed fraction with internal fixation
a) clean
b) clean-contaminated
c) contaminated
d) dirty
- clean contaminated
- (orthopedic)
- slide 40
-
what ppx for cardiothoracic and vascular surgery?
-
what ppx for cardiothoracic and vascular surgery if b-lactam allergy?
vanco or clinda
-
what ppx for cardiothoracic and vascular surgery, if high risk MRSA?
vanco
-
decolonization is not for everyone. but for SA colonized CT surgery pt, what can you consider?
- preoperative admin of intranasal mupirocin
- (controversial)
- (slide 44)
-
arterial surgery involving prosthesis, abdominal aorta, and legs requiring groin incision are all vascular surgery. what orgs are involved here?
- S aur
- S epi
- enteric GN bacilli
(slide 45)
-
lower extremity amputation for ischemia is a vascular surgery. what orgs are involved here?
- S. aur
- S. epi
- enteric GN bacilli
- clostridia
-
what ppx for vascular surgery?
- cefazolin or vanco
- or cefuroxime
-
what ppx for vascular surgery if pcn allergy?
-
2 examples of thoracic (non-cardiac) surgery?
- pulmonary resection
- closed tube throcostomy
- (slide 47)
-
prevalent bugs in thoracic, non cardiac, surgery?
- s aur
- s epi
- streptococci
- enteric GN bacilli
-
what ppx for thoracic, non cardiac, surgery?
-
head and neck surgery is usually clean. if prosthesis is added, what abx?
cefazolin
-
if head/neck surgery is clean/contaminated, what are the prevalent bugs?
- anaerobes
- enteric GN bacilli
- S. aureus
-
if head/neck surgery is clean/contaminated, what abx? how long do you continue the abx?
- cefazolin
- clinda + gent
- cefazolin + metro
- continue for 24h
-
neuro surgery has what bugs?
-
-
what abx ppx for spinal surgery? (cross sinuses or naso/oropharynx)
clinda
-
what abx ppx for CSF shunt?
-
what bugs in ophthalmic surgery?
- s. epi
- s. aur
- streptococcus
- enteric GN bacilli
- pseudo
-
what abx ppx for ophthalmic surgery?
- FQ drops - multiple over 2-24h
- neomycin-gramicidin-polymixin B drops
- AG drops
- cefazolin 100mg sugconjunct.
-
when can esophageal surgery can get infected?
when obstruction
-
risk factors for gastroduodenal surgery getting infected?
- obstruction
- hemorrhage
- gastric ulcer or malignancy
- H2 blocker/ PPI (inc pH so bacteria grow better)
- morbid obesity
-
risk factors for biliary tract surgery getting infected? what abx?
- >70yo
- diabetes
- obesity
- acute cholecystitis
- non-functioning gallbladder
- obstructive jaundice or common duct stones
- endoscopic retrograte cholangiopancreatography (ERCP)
- CEFAZOLIN!
-
do you need abx ppx if elective laparoscopic cholecystectomy for biliary tract surgery?
no if low risk (slide 53)
-
when do you need abx ppx for esopageal, gastroduodenal surgery? what abx?
- morbid obesity
- esophageal obstruction
- dec gastric acidity (H2, PPI)
- gastrointestinal motility
- CEFAZOLIN!
-
bilirary tract surgery has which bugs?
- enteric GN bacilli
- enterococci
- clostridia
-
appendectomy (non-perforated) has which bugs?
- enteric GN bacilli
- anaerobes
- enterococci
-
which abx ppx for appendectomy (non-perforated)?
- cefoxitin, cefotetan (for anaerobes)
- cefazolin + metro
- amp/sulbact
-
how long do you treat if perforation or complicated acute appendicitis from appendectomy?
5-7 days
-
what to do before colorectal surgery?
- remove feces with golytely
- po abx ppx 19, 18, and 9 h before surgery
- or iv abx ppx
-
what po abx ppx for colorectal surgery?
- neomycin +erythromycin base
- metronidazole (+ neomycin)
- 19, 18 and 9 h before surgery
-
what iv abx ppx for colorectal surgery?
- clinda + gent/cipro/aztreonam
- metro + gent/cipro
-
how long should the tx be if perforation happens during colorectal surgery?
5-7 days of tx
-
bugs in genitourinary surgery?
- enteric GN bacilli
- enterococci
-
when to give genitourinary abx ppx?
- high risk:
- urine cx (+) or unavail
- pre-operative catheter
- transrectal prostatic biopsy
- transurethral prostatectomy
- placement of prosthetic material
-
what abx ppx to give for genitourinary surgery?
- cipro 500mg po
- bactrim DS po 2 h before surgery
-
ppx?
cardiac catheterization
nope
-
-
ppx?
dermatologic and plastic sx
- nope
- unless >3h of surgery: give cefazolin
-
ppx?
arterial puncture, paracentesis, thoracetesis
nope
-
ppx?
simple laceration
nope
-
ppx?
outpatient treatment of burns
nope
-
ppx?
dental extraction or root canal therapy
nope
-
do you use 3rd and 4th generation cephalo for abx ppx surgery?
- nope
- (more expensive, less active than cefazolin)
- cefotaxime (Claforan)
- Ceftriaxone (Rocephin)
- cefoperazone (Cefobid)
- Ceftazidime (Fortaz)
- Cefepime (Maxipime)
-
can you use cefazolin if pcn allergy? what else can you use?
-
what kind of bacteria do vanco, clinda, cefazolin cover?
gram positive only!
-
what abx can you use for GN cover?
-
if pt is obese, what dose of cefazolin should you give?
- 2g instead of 1g
- slide 64
-
is vanco better than cefazolin for resistant org?
-
what carbapenem is FDA approved for elective colorectal procedure ppx? compare with cefotetan
- ertapenem
- erta is more effective than cefotetan for preventing SSI
- but may have inc C.diff
- not routinely recomm b/c broad spectrum
|
|
