Antibiotic Prophylaxis For Surgical Procedures

Patient-related risk factors that indicate the need for antibiotics

In most surgical procedures no prophylactic or postoperative antibiotics is required. However, some patient- and procedure-related factors shift the risk-benefit assessment towards a prophylactic administration. Patient-related risk factors that indicate the need of antibiotics Certain heart valve diseases immunosuppression interventions with a higher risk affect areas of the body where a bacterial colonization is common: oral gastrointestinal tract respiratory urogenital tract In so-called clean, that presumably sterile procedures is a prophylaxis usually only beneficial when prostheses are implanted or if the consequences of inflammation are serious known as such. B. mediastinitis after bypass surgery. The choice of antibiotics based on the “Surgical Care Improvement Project (SCIP) guidelines” (Perioperative Management). There is explicit evidence that the standardized antibiotic selection and adherence to SCIP protocols or other standardized and validated protocols reduce the risk of surgical infections. Some regions of the US, which followed the SCIP guidelines, were able to reduce posdtoperativer wound infections by 25% from 2006 by 2010. The substance selection is based on drug activity against bacteria commonly contaminating the wound under the specific intervention (see Table: Antibiotic treatment in certain surgical procedures). The antibiotic is within 1 h prior to surgery (2 h at vancomycin and fluoroquinolones) was added. Antibiotics can depending on the operation orally or i.v. are given. For most cephalosporins, another dose is administered when the process takes> 4 h. For clean operations, no additional doses are required, but in other cases it is unclear whether additional doses are beneficial. Antibiotics only be continued postoperatively beyond 24 hours, when intraoperatively an acute infection was detected. The antibiotic then counts as a treatment, not a prophylaxis. Antibiotic treatment for certain surgical procedures Surgical Procedure Recognized antibiotics cardiac or vascular cefazolin, cefuroxime or vancomycin When ?-lactam allergy: vancomycin or clindamycin hip / knee arthroplasty cefazolin, cefuroxime or vancomycin When ?-lactam allergy: vancomycin or clindamycin colon cefotetan , cefoxitin, ampicillin / sulbactam or ertapenem or cefazolin and metronidazole or cefuroxime and metronidazole or ceftriaxone and metronidazole When ?-lactam allergy: clindamycin and gentamicin or clindamycin and ciprofloxacin or clindamycin and aztreonam or metronidazole and gentamicin or metronidazole and ciprofloxacin hysterectomy cefotetan, cefazolin, cefoxitin, cefuroxime, or ampicillin / sulbactam When ?-lactam allergy: Clindamycin and gentamicin or clindamycin, and ciprofloxacin or clindamycin and aztreonam or metronidazole and gentamicin or metronidazole and ciprofloxacin, or vancomycin and aminoglycosides or vancomycin and aztreonam, or vancomycin, and quinolones Adapted from “the Specifications Manual for National Hospital Inpatient Quality Measures, Section 2.4 Surgical Care Improvement Project ( SCIP) , Version 4.3: 38-39, 2014 “. Available at QualityNet. More information Surgical Care Improvement Project (Version 4.3)

Health Life Media Team

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