Prophylactic Abx

Question 1

Why use prophylactic abx?

Answer 1

Estimated 0.5-1 million sx site infections annually in the US
For most procedures use of prophylactic abx has decreased risk of infection

Question 2

Purpose of prophylactic abx - General

Answer 2

Decrease the incidence of infection

Considered the standard of care for all but “clean” sx procedures

Question 3

Purpose of prophylactic abx - Decrease the incidence of infections

Answer 3

Not intended to eliminate bacteria

Question 4

Clean procedures

Answer 4

Elective
Non-traumatic
Not associated with acute inflammation
Do not enter respiratory, GI, biliary or GU tract

Question 5

Principles of prophylaxis

Answer 5

Choose abx effective against the expected contamination
Use abx only if the risk of infection justifies doing so
Give abx in appropriate doses and at appropriate times
Stop dosing before the risk of SE outweighs benefit

Question 6

Sx Care improvement measures aimed at prevention of sx site infections - General

Answer 6

Seven steps to help in the prevention of post-op infection by giving prophylactic abx prior to sx

Question 7

SCIP-1

Answer 7

Pre-op abx given within 1h before incision

Question 8

SCIP-2

Answer 8

Must received SCIP recommended prophylactic abx

Question 9

SCIP-3

Answer 9

D/c abx with 2
h of anesthesia end time (within 48h of cardiac sx end time)
Get as close to 24h w/o going over

Question 10

SCIP-4

Answer 10

Controlled 6am post-op serum glucose <200 mg/dl on post-op days 1 and 2 in cardiac sx

Question 11

SCIP-6

Answer 11

No or appropriate hair removal

Question 12

SCIP-7

Answer 12

Immediate post-op normothermia in colorectal sx

Temperature >96.8°F ~15min after anesthesia end time

Question 13

SCIP-5a

Answer 13

Post-op sx site infection dx during index hospitalization

Question 14

RF affecting infection risk

Answer 14

DM
Increased age
Obesity
Heavy alcohol consumption
Admission from long-term care facility
Multiple medical comorbidities

Question 15

Prophylactic abx choice - Characteristics

Answer 15

Should be cost-effective, safe and efficacious

Select to target the organisms most likely to be encounters in the anticipated operative procedure

Question 16

Prophylactic abx choice for GYN,colorectal procedures, and appy

Answer 16

Require better Gram negative and anaerobic activity

Examples

• Cefoxitin
• Cefotetan

Question 17

Prophylactic abx - Generally preferred choice

Answer 17

First generation cephalosporin (Cefazolin)
Effective against common Gram positive and Gram negative bacteria
Has a moderately long half-life

Question 18

When to give prophylactic abx

Answer 18

A single dose give IV within 1h prior to skin incision
Addition dosages for longer procedures
Post-op doses often not necessary
Prosthetic valve or valvular HD
Pts with indwelling prosthetic joints
When there is a significant rate of infection is encountered w/o them
When consequence of infection would be disastrous

Question 19

When to give additional doses of prophylactic abx

Answer 19

Repeat dose every 3-4h while operating OR

Those that require large volumes of resuscitative fluids

Question 20

The American Heart Association recommendations concerning prophylactic abx

Answer 20

Recommends prophylactic abx if prosthetic valve or valvular HD

Question 21

Why are regular dosed abx inappropriate for prophylaxis

Answer 21

Clean wounds may be come infected with organism for which prophylactic abx are ineffective
Multi-drug therapy increases risk of adverse drug reactions
Resistant organisms will eventually develop, creating a high risk of infection within the hospital
the expense and risk associated with abx overshadow the minimal beneficial effects of using abx in clean cases

Question 22

There is no reduction in sx site infections with

Answer 22

Pre-op bathing with antiseptic agents
Pre-op hair removal
- Use of razors increases risk of sx site infection
- If removing hair, use a clipper