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IOS 10 exam 4

Surgical site infections

QuestionAnswer
Endocarditis-Antimicrobial Prophylaxis Endocarditis-Dental -Amoxicillin 2 g or PCN clindamycin, cephalexin, cefadroxil, azithromycin, clarithroymycin
GU/GI- High risk-treatment High risk- Ampicillin 2g + gentamycin 1.5mg/kg or Vancomycin 1g + Gentamicin 1.5mg/kg Moderate- Amoxicillin 2 g or Vancomycin 1 g
High-Risk patients Prosthetic valves, Previous bacterial endocarditis, Cyanotic congenital heart disease, 4. Systemic pulmonary shunts or conduits
Moderate-Risk patients 1. Valvular dysfunction (e.g. rheumatic heart disease)2. Hypertrophic cardiomyopathy3. Mitral valve prolapse with regurgitation
Dental Prodedures (High risk & moderate risk) Prophylaxis recommended Dental extractions Periodontal procedures (root planting) Dental implant placement, Root canal Orthodontic band placement Local anesthetic injections Teeth cleaning where bleeding is anticipated
Surgical prophylaxis (high Moderate risk) -30 minutes prior to procedure, maintain 2 half-life’s except CABG, joint replacement (24-48hr)
No prophylaxis Clean surgery.Exceptions-Implantation of prosthetic material, Significant morbidity associated with infection (CABG, Neurosurgery, Vascular)
Surgery DOC prophylaxis DOC-Cefazolin PCN ALL-Gentamicin +- clindamycin or metronadizole or Levofloxacin + metronidazole MRSA-Vancomycin
Surgery (anaerobes) Apendectomy, colorectal, hysterectomy Cefotetan or Cefoxitin
Intra-abdominalSurgery DOC Cefoxitin, Neomycin Sulfate, Erythromycin, mechaniscal cleaning (mannitol, PEG, fleets phoso-soda).
Topical treatments Nasal- Mupirocin, Skin-chlorhexidine (MRSA
Potential Micorobes Staph, aureus, Coag (-) staph, enterococcus spp, E. coli, Pseudomonas
Surgical Wound Classification 1. Clean-No acute inflammation 2. Clean-contaminated -Controlled opening of GI, respiratory, biliary, or GU tract 3. Contaminated -Penetrating trauma (<4 hours old),4. Dirty-Penetrating trauma (>4 hours old),
Surgery Pathogens (Gram+ staph aureus) or intra-abdominal-E. coli, gram(-), Enteroccus, B. fragilis or Nasal- S. aureus
Created by: liza001
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