Salzer

Antibiotic Prophylaxis for Surgical Procedures Bill Salzer University of Missouri-Columbia 9/29/07 [email_address]

Preventing Surgical Infections ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

0 4 8 1 2 Alexander JW et al. Arch Surg. 1983;118:347–352. Hair-Removal Techniques and SSIs Infection, % Discharge 30-Day Follow-up 5.2% (14/271) 8.8% (23/260) 6.4% (17/266) 10% (26/260) 4% (10/250) 7.5% (18/241) 1.8% (4/226) 3.2% (7/216) PM AM PM AM Razor Razor Clipper Clipper

Perioperative Normothermia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kurz A et al. N Engl J Med. 1996;334:1209–1215.

Supplemental Oxygen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Greif et al. N Engl J Med. 2000;342:161–167.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SSIs and Glucose Levels (cont) Latham R et al. Infect Control Hosp Epidemiol. 2001;22:607–612.

SSIs and Post-op Glucose Levels Latham R et al. Infect Control Hosp Epidemiol. 2001;22:607–612. Adapted with permission from the University of Chicago Press © 2001. 3.32 28 (3%) 5 (7%) ≥ 300 2.97 69 (8%) 11 (15%) 250–299 2.54 154 (17%) 21 (29%) 200–249 1.00 651 (72%) 35 (49%) <200 (referrent) Odds ratio Noninfected patients (n=902) Infected patients (n=72) Glucose level (mg/dL)

SSIs and Glucose Levels 0 1 2 3 4 5 6 7 8 100–150 150–200 200–250 250–300 Day 1 Blood Glucose (mg/dL) Deep Infection Rate, % Zerr KJ et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations, page 360. Reprinted from The Annals of Thoracic Surgeons , Vol. 63. Copyright 1997, with permission from the Society of Thoracic Surgeons. All rights reserved. 1.3% 1.6% 2.5% 6.7% P =0.002

Preoperative Strategies to Limit SSIs: Skin Surface Preparations ,[object Object],[object Object],[object Object],[object Object],[object Object],1. Seal LA et al. Am J Infect Control. 2004;32:57–62. 2. Mangram AJ et al. Am J Infect Control. 1999;27:97–134.

Antimicrobial Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Prophylaxis- Principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Antibiotic Prophylaxis-Caveats ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evidence Based? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Major Pathogens in SSI 0% 5% 10% 15% 20% Infections, % Staphylococcus aureus Coagulase-negative Staphylococcus Enterococcus spp. Escherichia coli Pseudomonas aeruginosa Enterobacter spp. NNIS Report. Am J Infect Control. 1996;24:380–388.

Beta-lactams for Surgical Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Failure of Prophylaxis at 4 Weeks Posttreatment (Evaluable Population) C diff colitis 1.7% 0.6% 4.1 14 2.9 10 Anastomotic Leak 7.7 26 8.4 29 Unexplained Antibiotic Use 31 105 18.2 63 Surgical Site Infection – 13.3 – 20.4, – 6.1 42.8 145 29.5 102 Any Failure % 95% CI % n % n Reason for Failure Estimated Difference (A - B) Cefotetan (B) (n=339) Ertapenem (A) (n=346)

Penicillin Allergic? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vancomycin for Surgical Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Perioperative Prophylactic Antibiotics: Timing of Administration Infections, % Hours From Incision 14/369 5/699 5/1,009 2/180 1/61 1/41 1/47 15/441 0 1 2 3 4 ≤– 3 >–2 >–1 0 1 2 3 4 ≥ 5 Classen DC et al. N Engl J Med . 1992;326:281–286. Copyright © 1992 Massachusetts Medical Society. All rights reserved.

Surgical Prophylaxis- One Dose? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Impact of Prolonged Antibiotic Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CABG = coronary artery bypass grafting; CI = confidence interval. Harbarth S et al. Circulation . 2000;101:2916–2921.

Single- vs Multiple-Dose Surgical Prophylaxis: Systematic Review McDonald M et al. Aust NZ J Surg . 1998;68:388–396. Adapted with permission from Blackwell Synergy © 1998. Favors single dose Favors multiple dose All studies, fixed All studies, random Multi > 24h Multi < 24h

Website Resource www. surgical infection prevention .org

SIP Program Quality Indicators ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bratzler DW. Available at: http://www.medqic.org/scip/pdf/spkrnotesSIP_to_SCIP_101205.ppt . Accessed May 26, 2006.

Preventing Surgical Infections ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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