ANTIMICROBIAL PROPHYLAXIS

IN SURGERY

PROPHYLAXIS

ADMINISTERED BEFORE THE

INTENDED SURGICAL PROCEDURE
AT THE TIME OF THE INCISION
PREVENT BACTERIAL PROLIFERATION .
BACTERICIDAL AND GIVEN
INTRAVENOUS.
NEOMYCIN MAY BE USED IN BOWEL
PREPARATION FOR COLONIC
SURGERY.

ANTIBIOTIC PROPHYLAXIS
GUIDELINES

A SINGLE PREOPERATIVE DOSE OF

ANTIBIOTIC EFFECTIVE = FIVE
DAYS COURSE OF THERAPY
ASSUMING UNCOMPLICATED
PROCEDURE.
ADMINISTERED WITHIN 1 HOUR
INCISION, PREFERABLY WITH
INDUCTION OF ANESTHESIA.
TARGET ANTICIPATED ORGANISMS.

CONTD;

NOT BE EXTENDED BEYOND 24 HOURS FOLLOWING SURGERY.

ONE PREOPERATIVE AND TWO OR THREE POSTOPERATIVE DOSES

ARE SUFFICIENT IN CLEAN SURGERY.

CONTAMINATED AND DIRTY PROCEDURES SHOULD ADDITIONALLY

RECEIVE ADDITIONAL POSTOPERATIVE COVERAGE.

DURING PROLONGED PROCEDURES ANTIBIOTIC PROPHYLAXIS

SHOULD BE READMINISTERED EVERY 3 HOURS.

USE OF ANTIBIOTIC IN PROCEDURES CLASSIFIED AS

CONTAMINATED OR INFECTED SHOULD BE USED AS THERAPEUTIC
AND NOT PROPHYLACTIC.

CONTD;
IN

TRAUMATICALLY INJURED PATIENTS

ANTIBIOTICS CANNOT BE GIVEN BEFORE
BACTERIAL CONTAMINATION OCCURS.
CEPHALOSPORINS CEPHAZOLIN 1ST
LINE PROPHYLACTIC AGENT MOST
SURGICAL PROCEDURES LOW
TOXICITY, LONG SERUM HALF LIFE, BROAD
SPECTRUM OF ACTIVITY, LOW COST.
THIRD GENERATION NOT BE USED FOR
ROUTINE PROPHYLAXIS PROMOTE THE
EMERGENCE OF RESISTANCE.

NEUROSURGERY

Neurosurgery Procedure

Nosocomial CNS infections not often

occur potentially serious death
Narotam, et al divides into 5 catagories :
Clean
Clean with foreign body
Clean contaminated
Contaminated
Dirty

Risk Factor ASA classification >2,

prolong procedure, post op monitoring
(ICP, Ventricular drain, CSF leak)

Organism

Primarily Gram Positive (S. Aureus)

and coagulase negative staphylococcus
Others P. Acnes
5-8% polymicrobial infections

Efficacy

Clean procedure antimicrobial

prophylaxis (pediatric, adult) craniotomy
+ spinal procedure
Studies Cloxacillin / amoxicillinclavulanate, Clindamycin ( lactam
allergic), other low infection rate (5,8 %)
compare with no antibiotic prophylaxis
No difference emergency, clean
contaminated, dirty procedure, re-operate,
operative >> 4 hours)

Choice of Agent

Clean Procedure !!
Regiments
clindamycin
vancomycin,
cefotiam,
piperacillin,
cloxacillin,
oxacillin,
cefuroxime,
cefotaxime,
sulfamethoxazole-trimethropim,
cefazolin,
penicillin-G
amoxicillin-clavulanate

Duration

Recommendations cefazolin
Clindamycin or vancomycin (alternative
agent lactam allergy
Single dose 60 minutes before
incision

Efficacy for CSFShunting

Antimicrobial prophylaxis
recommended
Procedures Ventriculostomy, VPshunt, Intratechal pump placement, EVD,
ICP monitor
DOC cephalosporin i.v
Duration single dose prophylaxis
regiment / 24-48 hrs postoperatively

PLASTIC SURGERY

PLASTIC PROCEDURE

Focused
reconstructive,dermatological,and
cosmetic
Goal primary (restore function),
secondary (improving appearance)
Procedures dermatological, breast, head
and neck, facial, oral procedure (wedges excision
of lip or ear), flaps on the nose, etc

Organism

The Most S. Aureus

others Staphylococci and
streptococci
Procedures Macerated, Moist
environments,below the waist, pasien
with diabetes gram negative (P.
aeruginosa,serratia marcescensa,E.coli,
klebsiella sp.,P. Mirrabilis)

Efficacy

Doesnt significantly except

nonreconstructive breast cancer
procedure
Procedure without implant (-)
Procedure with implant (+)

Choice of agent

No consensus gram-positive,depending site

of surgery, gram negative (risk factor)
Cefazolin or ampicillin-sulbactam most case
Clindamycin and vancomycin (alternative)
Gram negative cefazoline (no allergy) or
azteronam, gentamicin, fluoroquinolone
(allergy)
Ear antipseudomonal fluoroquinolon
Oral cephalexin, amoxicillin,
clindamycin,azithromycin

Duration

Should be limited shortest duration

limit advers events + prevent resistance
No significant

Recommendation

No recommended clean procedures

Clean-contaminated, breast cancer,
clean-with risk factor cefazoline /
ampicillin-sulbactam (single dose),
clindamycin/vancomycin (allergic)

PEDIATRIC SURGERY

Background

SSI pediatric >>

Organism same as adult MRSA
rarely
No studies
Recommended DOC as adult,dosage
body wieght