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Flashcards in Antibiotics Deck (94)
1

What are methods in surgical technique that lead to less SSI?

gentle traction
Effective hemostasis
removal of devitalized tissues
obliteration of deadspace
irrigation with saline
fine non-absorbed suture
closed suction drains
wound closure without tension

2

What patient conditions may lead to increased SSI?

Extremes of age
malnourished
obesity
Diabetes
Recent operation
corticosteroid therapy
immunocompromised

3

What are perioperative factors that may increase SSI?

Body temperature
FiO2
fluid management
blood glucose
blood transfusion
antimicrobial prophylaxis

4

What are the benefits of normothermia during surgery?

wound healing
less vasoconstriction

5

how does hypothermia lead to SSI?

decreased tissue perfusion
decreased super oxide radicals
induced anti-inflammatory profile
decreased collagen production

6

More oxygen leads to _______ wound healing

improved

7

At what FiO2 is decreased incidence of SSI seen?

0.8

8

Which fluid is better for preventing SSI, colloid or crystalloid?

no difference

9

Why is keeping the patient euvolemic important for preventing SSI?

prevents subq tissue from being hypervolemic

10

HOw does hyperglycemia affect infection?

increased morbidity and mortality
Deactivation of immunoglobulins
functional deficits in neurtophil function

11

SSI is decreased with _____ PRBC transfusion

auto

12

HOw should rbc's be prepared to reduce risk of infection?

leukocyte reducted

13

What are the goals of surgical prophylaxis?

prevent postoperative SSI
Prevent post-op M&M
reduce duration of healthcare
Reduce cost of healthcare
Produce no adverse effects
Have no adverse consequences

14

What are the normal flora of the skin?

Staph epidermidis
staph aureas

15

What is the ideal antibiotic therapy

active against most likely pathogen
given in appropriate dosage
given at appropriate time
safe
administered for shortest period

16

when and how often are antimicrobials dosed?

1 hour before incision
must exceed minimum inhibitory concentration
Every 1-2 half lives, terminating within 24 hours

17

This type of proceure is elective, not emergency, nontraumatic, primarily closed, no breack in techinique. Respiratory , GI, biliary and GU tracts not entered

clean procedure

18

What is a contaminated procedure?

Nonpurilent inflammation, gross spillage from GI tract, entry ito GU or biliary tract i presence of infected bile or urine. penetrating trauma <4 hours old

19

Purulent inflammation (e.g., abscess); preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract; penetrating trauma > 4 hours old
l

dirty procedure

20

Urgent or emergency case that is otherwise clean; elective opening of respiratory, gastrointestinal, biliary or genitourinary tract with minimal spillage (e.g., appendectomy) not encountering infected urine or bile; minor technique break

clean contaminated

21

Nonpurulent inflammation; gross spillage from gastrointestinal tract; entry into biliary or genitourinary tract in the presence of infected bile or urine; major break in technique; penetrating trauma

contaminated procedure

22

Which antibiotic should be used for clean procedures?

cefazolin 1-2 grams IV

23

What antibiotic should be given for thoracic/orthopedic procedures?

cefuroxime 1.5 grams IV

24

What antibiotics should be given for bowel procedures?

cefoxitin 1-2 grams IV
cefazolin 1-2 gram + methonidazole 500mg
Ampicillin/subactam (unasyn) 3 grams

25

What class of antimicrobial is ampicillin and amoxicillin?

penicillinase with gram (-) activity

26

What class of antimicrobial is methicillin, oxacillin and nafcillin?

Pinicillinase-resistant

27

What class of antimicrobial is ampicilln-sulbactam

penicillin with beta lactamase inhibitor

28

What class of antimicrobial is imipenem?

carbapenem

29

What class of antimicrobial is gentamicin, tobramycin?

aminoglycosides

30

What class of antimicrobial is erythromycin, clrithomycin?

macrolide

31

What class of antimicrobial is clindamycin

lincomycins

32

What class of antimicrobial is vancomycin?

glycopeptide derivative

33

What class of antimicrobial is ciprofloxacin, levofloxacin?

fluroquinolones

34

Cephazolin belongs to which cephalosporin class?

1st generation

35

Cefuroxime (and cefaclor) belongs to which cephalosporin class?

2nd generation

36

ceftizoxime belongs to which cephalosporin class?

3rd generation

37

Cefclidine and cefepime belongs to which cephalosporin class?

4th generation

38

As the generation of cephalosporin increases, there is increased coverage for gram _____, while some coverage for gram ____ is lost

negative
positive

39

Which abx may be used if pt is allergic to penecillin?

Vancomycin 1gram (15 mg/kg)
clindamycin (600-900 mg)

40

What abx may be used to add gram negative coverage?

gentamicin
ciprofloxacin
levofloxacin
aztreonam

41

What are the possible benefits of adding vancomycin to the mix?

prevention of MRSA
prosthetic heart valve and vascular graft
recent broad spectrum therapy
--studies show no benefit to using vanc.
-muse be cautious due to increased incidence of VRE

42

Repeat dosing shows no benefit in procedures +/- ___ hours but significant benefit in those > ____ hours

4, 7

43

How long are antibiotics given post closure?

24 hours (most)
48 hours (cardiac)

44

REpeat dosing for Cefazolin

2-5 hour

45

Repeat dosing for cefoxitin

2-3 hour

46

Repeat dosing for cefuroxime

3-4 hours

47

Repeat dosing for Ampicillin/sulbactam

2-4 hours

48

Repeat dosing for Nafcillin

2 hours (used for neurosugery

49

Repeat dosing for Vancomycin

6-12 hours

50

Repeat dosing for clindamycin

3-6 hours

51

Repeat dosing for metronidazole

6-8

52

What organisms do you need to treat for in neurosurgery? How do you treat it?

staph aureus, s. epidermatis
Cefazolin (1-2g)
Nafcillin(1-2g)
Vancomycin (1-2g)

53

Head and neck procedures are clean or clean-contaminated t or f?

true

54

What organisms are in head and neck?

Mouth: streptococci, S. epidermidis
Nose: Staph and strep

55

What are recommendations for head and neck surgery?

Clean: Not clear
Clean-contaminated:
Cefazolin (1-3g)
Clindamycin (600-900mg) + gentamicin(1.5/mg/kg)

56

Cardiac Sx is clean contaminated. T/F

F. Clean
Low risk but catastrophic complications

57

Organisms associated with cardiac Sx.

S. aureus and coagulase-neg staph
Gram (-) bacilli with saphenous vein harvest

58

Recommendations for cardiac Sx

Cefuroxime is agent of choice
Vancomycin and clindamycin are alternatives

59

Organisms associated with noncardiac thoracic Sx

same as cardiac
S. aureus and coagulase-neg staph

60

recommendations for noncardiac thoracic Sx

Cefazolin (1-2 grams)
Cefuroxime (1.5 grams)
Vancomycin* (1 gram [10-15 mg/kg])
Clindamycin** (600-900 mg)

61

organisms associated with Colorectal Sx

Gram-neg bacilli, anaerobes, enterococci

62

recommendations for Colorectal Sx

Oral regimen
-Neomycin + erythromycin
-Neomycin + metronidazole
Intravenous regimen
-Cefazolin (1-2 g) + metronidazole (0.5 g)
-Cefoxitin or cefotetan (1-2 g)
-Ampicillin-sulbactam (3 g)

63

what are recommendations for colorectal Sx for PCN and Cephalosporin allergic pts

Clindamycin (600-900 mg) plus
-Gentamicin (1.5 mg/kg) or
-Ciprofloxacin (400 mg) or
-Levofloxacin (750 mg) or
-Moxifloxacin (400 mg)
Metronidazole + aztreonam (1-2 g) + gentamicin

64

Organisms associated With GI-Appendectomy

Aerobic / anaerobic gram-neg enteric

65

Recommendatinos for GI-appendectomy

Cefoxitin (1-2 g)
Ampicillin-sulbactam (3 g)
Cefazolin (1-2 g) + metronidazole (0.5 g)

66

Recommendations for GI-appendectomy-PCN allergic

Clinamycin + gentamicin (cipro, Levo)

67

Organisms associated with esophageal and gastroduodenal Sx

E. coli, staph, strep, enterococci

68

Recommendations for esophageal/gastroduodenal Sx

cefazolin (1-2 g)

69

Recommendations for esophageal/gastroduodenal Sx-PCN or cephalosporin allergy

Clindamycin +
-Ciprofloxacin, Levofloxacin, gentamicin

70

Organisms-GI-Biliary tract

E.coli, Klebsiella, enterococci

71

recommendations for GI-Biliary tract

Cefazolin (1-2g)
(may ask for cefoxitin just in case they puncture the gut

72

recommendations for GI-Biliary tract-PCN or cephalosporin allergy

Clindamycin +
-Ciprofloxacin, Levofloxacin, gentamicin

73

Recommendation-clean orthopedic procedures

None

74

organisms-orthopedic

S. epidermidis, S. aureus, gram- neg bacilli

75

which orthopedic procedures should antibiotic be used for

Hip repair, joint replacement, fixation

76

What are recommendations if you ar going to give prophylaxis for orthopedic procedures?

Cefazolin (1-2 g)
Vancomycin (1 g)
Other options
-Antimicrobials in bone cement
-Ultraclean O.R.

77

how often does endometritis happen in cesarean?

85%
-prolonged labor and ruptured membranes

78

Organisms-cesarean delivery

Vaginal tract: strep, staph, enterococci
Wound: S. Aureus, staphylococci

79

recommendation-cesarean delivery

Single dose of cefazolin before incision
-Historically post clamping
Clindamycin+gentamicin

80

Organisms-hysterectormy

Post op differs from Pre-op
polymicrobial

81

recommendation-hysterectomy

Cefazolin, Cefoxitin, Ampicillin-Sulbactam
Clindamycin or Vancomycin + aminoglycoside, aztreonam or fluoroquinolone
Metronidazole + aminoglycoside or fluroquinolone

82

Organism-GU

E. coli

83

Procedures indicating prophylaxis for GU Sx

any transurethral Sx or catheter placement

84

Recommendations for GU

Clean procedures—cefazolin
Clean contaminated—see bowel prophylaxis
Aminoglycoside + metronidazole or clindamycin

85

Infections associated with vascular Sx are associated with extensive morbidity and mortality. T or F

T

86

Organisms associated with vascular Sx

S. aureus, S. epidermidis, gram-neg bacilli

87

Recommendations-vascular Sx

Cefazolin (1-2 g)
Vancomycin (1g ) ± gentamicin (2 mg/kg)

88

Which procedures are at a high risk for SBE?

Prosthetic heart valves
-Biprosthetic and homograft valves
Prior history of IE
Complex cyanotic congenital heart dz
-Transposition of great vessels, single ventricle, Tetralogy of Fallot
Surgically constructed systemic and pulmonary conduits

89

Which procedures are at a moderate risk for SBE?

Other congenital cardiac malformation
-Bicuspid aortic valve
Acquired valvular dysfunction
-AS, MS or valve repair
Hypertrophic Obstructive Cardiomyopathy
Mitral valve prolapse
-With regurgitation on auscultation
-Thickened leaflets on echo

90

Which procedures are at a low risk for SBE?

Physiologic or innocent murmurs
Isolated secundum ASD
Repair of ASD,VSD or PDA
MVP without regurgitation
Aortic valve sclerosis
Physiologic MR on echo
Mild TR
CAD, rheumatic fever, pacemaker, stent

91

What are AHA guidelines for SBE prophylaxis?

Situations in which the risk of IE is considered by most authorities to be high
Antimicrobial prophylaxis is generally accepted as advisable
Conditions in which risk of IE is considered moderate

92

ABX for SBE prophylaxis

Ampicillin (2 g)
Gentamicin (1.5 mg/kg; 120 mg max)-For GI and GU
PCN allergy
-Clindamycin (600 mg)
-Cefazolin (1 g)
-Vancomycin (1 g)
± Gentamicin for GI and GU

93

What can occur if vancomycin is given too fast? What are the symptoms? How should vanco be given?

Redman syndrome
Pruritus, flushing, erythema of head and torso
Arterial hypotension
Give over 1 hour

94

What happens if gentamycin is given too quickly? How fast should it be given?

Ototoxicity
give aminoglycosides over 20-30 minutes