SSI Flashcards
what is the most common pathogen causing SSIs
s. aureus
MRSA screening recommendations
screening and nasal mupirocin decolonization for s aureus colonized patients before total joint replacement and cardiac procedures
vancomycin should not me as prophylaxis to MRSA neg patients
if positive for MRSA
do a preoperative decolonization
2% nasal mupirocin BID for 5days
preoperative dose timing
at a time that serum and tissue conc exceeding MIC for the organism associated with the procedure, at the time of incision ,and for the duration of the procedure
what is the optimal time for administration of pre operative doses
within 60 minutes
agents that require 1-2 hrs administration within 120 minutes ( vancomycin , fluroquinolones)
intra-oprerative -dosing
redosing for all patients is needed to ensure adequate serum and tissue concentrations of the antimicrobial
if duration of the procedure exceeds 2 half lives of the drug
or there’s excess blood loss during the procedure
who is linked to an increased risk for SSI
obesity
cefazolin surgical dosing prophylaxix
-2mg < 120 kg
-3mg >= 120 kg
what is the duration of prophylaxis
the shortest effective duration
- less than 24 hours
– a single does
–48 hours for cardiothoracic procedures
what is the risk of prophylaxis
alter individual and institutional material flors
leading to changes in colonization rates and increase resistance
predispose patients to clostridium difficile associated colitis
criteria for SSI
need at least 1
-purulent incisional drainage
-positive culture of aseptically obtained from superficial wound
-pain, tenderness, swelling, and erythema after incision is open
-diagnosis of SSI by attending surgeon or physician
management of SSI
suture removal plus incision and drainage
adjunctive systemic antimicrobial therapy is NOT indicated
unless associated with a significant systemic response
subcutaneous abscess+ no systemic signs =
incision and drainage
fever in first 48 (up to 4 days)
systemic illness
wound drainage or marked local signs inflammation
gram stain to rule out streptococcus and clostridia
streptococcus and clostridia found in gram stain
open wound, debride
start penicillin ans clindamycin
fever > 4 days after operations
erythema and or induration
—> open wound —> no symptoms
dressing changes, no antibiotics
