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Pharm - Surgical Antimicrobial Prophylaxis

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morauch630's version from 2017-11-15 06:11

Section 1

Question Answer
List the the two types of surgical site infections:1. Incisional 2. Organ/space
Describe where a superficial incisional surgical infection would be:Skin or subcutaneous tissue
Describe where a deep incisional surgical infection would be:Fascia and muscle
Describe where an organ/space surgical infection would be:Involve an anatomic area other than the incision
To be considered a surgically related infection, infection must occur:with in 30 days of surgery
List the 15 patient risk factors related to surgical site infection:1. Age (old/very young) 2. Nutritional status (poor nutrition) 3. Diabetes (uncontrolled) 4. smoking 5. Obesity 6. Coexisting infections at distal body sites (really anywhere) 7. Colonization with resistant microorganisms (MRSA) 8. Altered immune response 9. Increased preoperative stay 10. Longer than avg. surgical procedure 11. abdominal surgery 12. shaving the incision site 13. More than 3 underlying surgical diagnosis 14. Surgical technique 15. Instrument sterilization
True or False: If you have a longer preoperative stay you have a decreased risk for surgical site infectionFalse
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Risk factors

Question Answer
T/F middle age is a risk factorF. Age (old/very young)
T/F Nutritional status (poor nutrition) is a risk factorT
T/F Controlled diabetes is a risk factorF. Diabetes (uncontrolled)
T/F. Surgical techniqueT
T/F Proper instrument sterilization is a risk factorF. Improper
T/F ObesityT
T/F Coexisting infections at distal body sites (really anywhere)T
T/F Colonization with resistant microorganisms (MRSA)T
T/F Altered immune responseT
T/F Increased preoperative stayT
T/F Shorter than avg. surgical procedure is a risk factorF. Longer than average
T/F Shaving the incision siteT
T/F abdominal surgeryT
T/F More than 3 underlying surgical diagnosisT
T/F SmokingT
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Section 3

Question Answer
Criteria for a clean woundNo acute inflammation or transection of GI tract, oropharyngeal, genitourinary, biliary, or respiratory tracts. Elective case, no technique break
Criteria for a clean-contaminated woundControlled opening of above tracts with minimal spillage /minor technique break. Clean procedures performed emergently or with major technique break
Criteria for a contaminated woundAcute, nonpurulent inflammation present. Major spillage/technique break during clean-contaminated procedure
Criteria for a dirty woundObvious preexisting infection present (abscess, pus, or necrotic tissue present)‏
Elective caseNot indicated unless high-risk procedure
No acute inflammation or transection of GI tract, oropharyngeal, genitourinary, biliary, or respiratory tractsNot indicated unless high-risk procedure
Controlled opening of GI tract, oropharyngeal, genitourinary, biliary, or respiratory tractsProphylactic antibiotics recommended
Clean procedures performed emergently Prophylactic antibiotics recommended
No technique breakNot indicated unless high-risk procedure
Major spillage/technique break during clean-contaminated procedureProphylactic antibiotics recommended
Acute, nonpurulent inflammation present. Prophylactic antibiotics recommended
Obvious preexisting infection present (abscess, pus, or necrotic tissue present)‏Therapeutic antibiotics recommended
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Section 4

Question Answer
What type of antibiotics do clean wounds needsNot indicated unless high-risk procedure
Clean-contaminatedProphylactic antibiotics recommended
ContaminatedProphylactic antibiotics recommended
DirtyTherapeutic antibiotics recommended
High risk procedurepatient with lots of comorbidities, break in sterility, prosthetic device inserted
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Section 5

Question Answer
Major Pathogens in Wound Infections (8)Staphylococcus aureus – 20% Coagulase-negative staphylococci – 14% Enterococcus spp. – 12% Escherichia coli – 8% Pseudomonas aeruginosa – 8% Enterobacter spp. – 7% Proteus mirabilis – 3% Klebsiella pneumoniae – 3%
Most common pathogen for wound infectionsStaphylococcus aureus – 20%
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Section 6

Question Answer
T/F Agent should be delivered to the surgical site after to the initial incision.F. Agent should be delivered to the surgical site prior to the initial incision. Needs to be active.
T/F Giving antibiotics early decreases risk of surgical infection and improves patient outcome. F. Giving antibiotics too early or late increases risk of surgical infection. Needs to be be active.
Antibiotics should be given within the first _____ prior to the first incision60 min
T/F Bactericidal antibiotic concentrations should be maintained at the surgical site throughout the surgical procedureT. Multiple doses may be needed if surgery is long. 4-7 hours usually give second dose
Antibiotic should cover likely pathogens based on site of incisionT.
In most cases post-op doses is neededF. In most cases no post-op doses needed
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Section 7

Question Answer
Antibiotic recommendation for most procedures1 G cefazolin (Ancef, Kefzol) at induction of anaesthesia
Antibiotic recommendation for appendectomy (for anaerobic bacteria)Cefoxitin (Mefoxin) 1-2 G at induction Cefotetan (Cefotan) 1-2 G at induction (you want more coverage for anaerobics)
Bowel proceduresNeomycin 1 G AND erythromycin 1 G ORALLY at 19, 18, and 9 hours pre-op
Cesarean section and hysterectomyCefazolin (Ancef, Kefzol) 2 G at cord clamp Cefazolin (Ancef, Kefzol) 1 G OR cefotetan (Cefotan) 1 G at induction
For bowel procedures when do you give Neomycin 1 G AND erythromycin 1 G po19, 18, and 9 hours pre-op
If a patient is allergic to pcns during a cesarean section and hysterectomy what abc do you give?Clindamyacin. If looking for gram neg you may add another drug. Depending on pt allergy and procedure
What does clindamyacin cover gram positive and anaerobes.
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Section 8

Question Answer
Grade-risk for bacterial endocarditis - Presence of surgical pulmonary shuntsHigh risk condition
Grade-risk for bacterial endocarditis - Complex cyanotic congenital heart disease High risk condition
Grade-risk for bacterial endocarditis - Prosthetic valves High risk condition
Grade-risk for bacterial endocarditis - Previous endocarditis High risk condition
Grade-risk for bacterial endocarditis - Most other CHDModerate risk condition (may think about giving prophylactic abx)
Grade-risk for bacterial endocarditis - Mitral valve prolapse Moderate risk condition
Grade-risk for bacterial endocarditis - Cardiac hypertrophy Moderate risk condition
When should prophylactic antibiotics be given with dental proceduresHigh risk. Any manipulation of gingival tissue, dental periapical region, or perforation of the oral mucosa
Describe dental proceduresExtractions, implantations, root canal, periodontal procedures, cleaning (if bleeding is expected)‏. Wisdom teeth
What procedures are prophylaxis antibiotics consideredIncision of the respiratory mucosa Ie. Tonsillectomy, adenoidectomy, rigid bronchoscopy
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Section 9

Question Answer
Esophageal manipulations
ERCP with biliary obstruction
surgery on/through intestinal mucosa
biliary surgery
Prostate surgery,
urethral diltation
cystoscopy
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Section 10

Question Answer
Standard prophylaxis for bacterial endocarditisAmoxicillin 2 G PO 1 hour prior to procedure
Prophylaxis for bacterial endocarditis if pt unable to take oral medicationsAmpicillin 2 G IM or IV 30 minutes prior to procedure
Prophylaxis for bacterial endocarditis if pt has penicillin allergyCephalexin (Keflex) 2 G PO 1 hr prior to procedure OR clindamycin 600mg PO 1 hr prior to procedure OR azithromycin (Zithromax) 500 mg PO 1 hr prior to procedure OR clarithromycin (Biaxin) 500mg 1 hr prior to procedure
Prophylaxis for bacterial endocarditis if pt has penicillin allergy and unable to take oral medicationscefazolin (Ancef, Kefzol) 1 g IV 30 minutes prior to procedure OR Clindamycin 600mg IV 30 minutes prior to procedure
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Section 11

Question Answer
Pathogens Expected from one of these procedures (3)1. Streptococci viridans 2. Enterococci 3. Staphylococci
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