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Flashcards in Surgical Prophylaxis Deck (41)
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1

Risk factors for VRE (vancomycin-resistant enterococci)

Concomitant diseases
Immunosuppression
ICU admission
Previous intraabdominal or cardiothoracic surgery
Indwelling catheters
Prolonged course of abx

2

IDSA guidelines of preadministration of abx

Within 60 mins of incision; FQs and vanc should begin within 120 mins of incision

3

Duration of prophylaxis

New recommendations short course of post-operative course of abx
Majority of post-op abx course must complete within 24 hrs of anesthesia close time
Cardiothoracic x 48 hrs

4

Cefazolin in obesity

Dosing shown in obese pts to lead to more SSIs for surgical prophylaxis
2 gms for pts >80 kg
3 gms for pts >120 kg
PK/PD data conflicting

5

Bacterial colonization with MRSA

Presence of bacteria on a body surface without causing an infection- colonization
Long-lasting
Pt with MRSA colonization has increased risk for MRSA infections
MRSA carriers also serve as reservoirs for future transmission

6

IDSA guidelines for MRSA colonization

Vanc + abx of choice for procedure should be used for institutions that have a high prevalence of MRSA SSIs and for pts who are known to be colonized with MRSA and/or have a hx of a MRSA infection

7

Urologic preop

E. coli
First line: FQ (levofloxacin 500 mg IV/po) x 1 dose
Allergy: Aminoglycoside (gentamicin 5 mg/kg) with or without clindamycin (900 mg) IV x 1 dose

8

Colorectal (enteric gm-neg bacilli and anaerobes) preop

First line: ceftriaxone 2 gm IV x 1 dose + metronidazole 500 mg IV x 1 dose or ertapenem 1 gm IV x 1 dose
Ceftriaxone preferred over ertapenem
Beta-lactam allergy: Clindamycin 900 mg IV + aminoglycoside (gentamicin 5 mg/kg) IV OR
Metronidazole 500 mg IV + aminoglycoside

9

Colorectal postop

Ceftriaxone and Ertapenem (no postop)
Metronidazole 500 mg IV q8h x 24 hrs
Duration: Preop single dose or <24 hrs
Ceftriaxone is preferred over Ertapenem
Flagyl causes a reaction with EtOH (disulfuram)- not even mouthwash or cough syrup

10

Neuro preop

S. aureus
First line: Cefazolin 2 gms (>80 kg) IV x 1 dose
Beta-lactam allergy: Vanc (15 mg/kg) OR
Clindamycin 900 mg IV x 1 dose

11

Gyn postop

Cefazolin 2 gms IV q8h x 24 hrs
Duration: <24 hrs

12

Beta-lactams MOA

Inhibits bacterial cell wall synthesis

13

SEs of beta-lactams

Anaphylaxis, hives, pseudomembranous colitis, seizures (rare)

14

Examples of beta-lactams

Pen G
Nafcillin/Oxacillin
Ampicillin/sulbactam (beta-lactamase inhibitor)

15

Indication for beta-lactams

Streptococci
Enterococcus
S. aureus

16

Cephalosporins MOA

Inhibits bacterial cell wall synthesis

17

SEs of cephalosporins

Skin rash
Diarrhea
Leukopenia

18

Aminoglycosides MOA

Interferes with bacterial protein synthesis by binding to 30s and 50s ribosomal subunits

19

SEs of aminoglycosides

Renal function, hearing impairment, ataxia, confusion, and C. difficile-associated diarrhea

20

Examples of aminoglycosides

Gentamicin
Tobramycin
Amikacin

21

Vancomycin MOA

Inhibits bacterial cell wall synthesis

22

SEs of vancomycin

Associated with nephrotoxicity, Red Man Syndrome (histamine release)

23

Pharmacokinetic monitoring of vancomycin

Peaks and troughs

24

Indication of Vancomycin

Gram + (including methicillin resistant)

25

FQs MOA

Inhibits DNA gyrase, promoting the breakage of DNA strands

26

SEs of FQs

Associated with N/V, potential to prolong the QT interval, potential to produce hypoglycemia (elderly) tendon inflammation/rupture

27

Examples of FQs

Levofloxacin
Ciprofloxacin
Moxifloxacin

28

Indication for FQs

Broad-spectrum gram pos and gram neg +/- anaerobes, +/- pseudomonas

29

Dosing of abx

Lipophilic drugs- use ABW
Hydrophilic drugs- use IBW

30

Cardiac/thoracic preop

S. aureus
First line: Cefazolin 2 gms (>80 kg) IV x 1 dose
Beta-lactam allergy: Vanc 15 mg/kg or Clinda 900 mg x 1 dose