Antibiotic Prophylaxis in Surgery

Question 1

Which of these procedures warrant Abx prophylaxis (all that apply)?

a) TLH
b) anterior repair
c) laparoscopic BSO
d) hysteroscopy D and C
e) hysteroscopy rollerball ablation
f) aspiration and curettage

Answer 1

a) yes
b) yes
c) no
d) no
e) no
f) yes but not D and C for missed

Question 2

Select all correct answers:

a) prophylactic Abx are recommended to prevent endocarditis in patients with valvular disease undergoing TAH
b) Abx should be given at time of incision for open surgery
c) if laparoscopic TLH exceeds 4 hours a second dose of prophylactic Abx should be given
d) patients with BMI > 30 should receive a double dose Abx

Answer 2

a) false
b) false 15-60 minutes prior to incision for all surgery
c) false -repeat dosing only for open (at 3 hour mark) or if EBL > 1500cc
d) false -consider doubling dose if BMI > 35

Question 3

List 5 types of infection which prophylactic Abx may help prevent.

Answer 3

1. wound/surgical site infection (skin cellulitis/abscess/dehiscence)
2. UTI
3. pelvic infection/abscess
4. cuff cellulitis
5. endometritis

Question 4

Choose all correct answers:

a) 10% of patients report an allergy to penicillin
b) of those tested, 10% of patients reporting allergy to penicillin will actually have positive allergy testing
c) if true penicillin allergy, there is a 10% risk of cross-reactivity with cephalosporins
d) the recommended 2nd line agent for patients with penicillin allergy is 600mg IV clindamycin

Answer 4

a) true
b) true
c) true
d) true

Question 5

Which patients are considered “high risk” for infective endocarditis?

Answer 5

1. prosthetic cardiac valve
2. previous infective endocarditis
3. congenital heart disease unrepaired, or repaired < 6 months old, or repaired with residual defect/disease
4. cardiac transplant patient with valvulopathy