Antimicrobial Surgical Prophylaxis
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WHO CME ANTIBIOTIC STEWARDSHIP ITALY • Articulate the principles of antimicrobial use in surgical prophylaxis • Describe how key institution-specific protocols can improve the use of antimicrobials for surgical prophylaxis • Appreciate the importance of pre-operative dosing and limiting prophylactic antimicrobials to the duration of the surgical procedure
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Antimicrobial Surgical Prophylaxis
- 2. Course content Courseroadmap Basic concepts Common infections 2
- 3. “This may even bring the end of modern medicine as we know it. We need to act now to make sure this does not happen.” Remarks at a high-level dialogue on antimicrobial resistance with UN Member States Dr. Margaret Chan New York, USA April 2016 3
- 4. Core competencies for antimicrobial prescribing C1: Understands the patient and the patient’s clinical needs C2: Understands treatment options and how they support the patient’s clinical needs C3: Works in partnership with the patient and other healthcare professionals to develop and implement a treatment plan C4: Communicates the treatment plan and its rationale clearly to the patient and other health professionals C5: Monitors and reviews the patient’s response to treatment 4 Core Competencies
- 5. Objectives • Articulate the principles of antimicrobial use in surgical prophylaxis • Describe how key institution-specific protocols can improve the use of antimicrobials for surgical prophylaxis • Appreciate the importance of pre-operative dosing and limiting prophylactic antimicrobials to the duration of the surgical procedure. 5
- 6. Surgical Site Infections • Common • Costly • Increase morbidity and mortality 6
- 7. Antimicrobial Surgical Prophylaxis 10%-20% of inpatient antimicrobial use Often sub-optimally administered 7
- 8. Surgical Site Infections Reduction in efficacy due to antimicrobial resistance could result in an additional surgical site infections 8
- 9. Clinical Case 1 Subsequent evaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment 9
- 10. 32 yo female s/p Caesarean delivery Post-operative vital signs stable Received 1st-generation cephalosporin 10 minutes after the surgical incision Does she need further antibiotics? 10
- 11. Principles of antimicrobial use in surgery • Use when indicated • Chose an antimicrobial active against the most likely organisms • Administer antimicrobials appropriately • Limit the duration W D 11
- 12. When is prophylaxis indicated? Surgical category Antimicrobial prophylaxis Antimicrobial treatment Clean Clean-contaminated Contaminated Infected 12
- 13. When is prophylaxis indicated? Surgical category Antimicrobial prophylaxis Antimicrobial treatment Clean Clean-contaminated Contaminated Infected 13
- 14. When is prophylaxis indicated? Surgical category Antimicrobial prophylaxis Antimicrobial treatment Clean Clean-contaminated Contaminated Infected 14
- 15. Which agent should you choose? Surgical category Prophylaxis Likely pathogens Spectrum of coverage Clean Gram- positives, esp GPCs Skin flora including staphylococci Clean- contaminated Gram- negative bacilli and enterococci Enterics/GU dictated by site 15
- 16. Consider patient factors • Antibiotic allergies • Colonization with resistant organisms 16
- 17. Which agent should you choose? Surgical category Prophylaxis Likely pathogens Spectrum of coverage Clean Gram- positives, esp GPCs Skin flora including staphylococci Prophylactic agent selected 1st generation cephalosporin 17
- 18. Dosing and Delivery • Most surgical prophylaxis is intravenous • Attention to weight based dosing 18
- 19. Duration and Timing of Antimicrobials • Antibiotics should reach acceptable serum and tissue concentrations prior to the incision time 19
- 20. Re-dosing • Prolonged surgical case • Excessive blood loss 20
- 21. Return to Clinical Case 1 Subsequent evaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment 21 Antimicrobial administered AFTER incision
- 22. Duration of antimicrobials? • additional post-operative doses do not further decrease SSI risk • Limiting duration of antimicrobials is important in reducing emergence of AMR 22
- 23. Other risk factors for SSIs • infection control practices • pre-operative preparation • duration of the procedure • surgeon technique Extrinsic/system factors 23
- 24. Other risk factors for SSIs • co-morbid conditions • skin preparation • glucose control • temperature Intrinsic/patient factors 24
- 26. Review: Antimicrobial Surgical Prophylaxis Drug Dose Duration Route prescription ............. ............. ............. 26
- 27. Review: Antimicrobial Surgical Prophylaxis Drug Dose Duration Route prescription ............. ............. ............. Use prophylaxis when indicated. 27
- 28. Review: Antimicrobial Surgical Prophylaxis Drug Dose Duration Route prescription ............. ............. ............. Chose an antimicrobial active against likely organisms 28
- 29. Review: Antimicrobial Surgical Prophylaxis Drug Dose Duration Route prescription ............. ............. ............. Administer antimicrobials appropriately and limit duration 29
- 30. Review: Antimicrobial Surgical Prophylaxis Drug Dose Duration Route prescription ............. ............. ............. Work to prevent SSIs is critical for patient care and requires a collaborative effort. 30
- 31. Quiz time! Please click “Next” to proceed.