Join Trisha Peel, Michael Calderwood, and Patch Dellinger in a lively discussion on perioperative antibiotic management and surgical site infection prevention. Delve into controversies like post-op antimicrobial prophylaxis duration, vancomycin use, and pre-op cefazolin for penicillin-allergic patients. Learn about the importance of judicious antibiotic use in optimizing patient care and collaboration between surgery and antimicrobial stewardship for better outcomes.
Optimal management of perioperative antibiotics is crucial to prevent surgical site infections.
Screening for MRSA colonization and decolonization strategies are essential in infection prevention protocols.
Vancomycin use in hip and knee replacements may not reduce the risk of surgical site infections for non-colonized patients.
Deep dives
The Impact of Duration and Type of Post-Op Antimicrobials
The podcast explored the impact of duration and type of post-operative antimicrobials on patients undergoing surgery, emphasizing that every additional day of antimicrobial use matters. Research highlighted in the episode showed that increasing the duration of surgical prophylaxis did not reduce surgical site infections and was associated with increased risks of acute kidney injury and Clostridium difficile infections. New guidelines suggested discontinuing antimicrobial prophylaxis at the time of surgical closure to mitigate these risks.
Decolonization Strategies and Evidence for MRSA Screening
The discussion delved into the importance of screening for MRSA colonization and the efficacy of decolonization strategies in preventing surgical site infections. Studies mentioned highlighted the need to address both methicillin-resistant Staph aureus (MRSA) and methicillin-susceptible Staph aureus (MSSA) in preoperative screening and decolonization efforts. The episode emphasized the significance of a holistic infection prevention approach, considering patient optimization, specific procedures, and evidence-based protocols.
The Use of Vancomycin in Joint Replacements
The episode presented findings from the ASAP trial focusing on the use of vancomycin in hip and knee replacements. The study, involving over 4,000 patients, found that adding vancomycin to standard prophylaxis did not reduce the risk of surgical site infection in patients without MRSA colonization. In fact, in knee replacements, vancomycin was associated with an increased risk of infection compared to cephalosporin alone. These results influenced practice changes, prompting surgeons to discontinue vancomycin use in joint replacements for non-colonized patients.
Collaboration in Antibiotic Stewardship
Ensuring proper administration of first-line antibiotics is vital in mitigating surgical site infection (SSI) rates. Studies reveal that patients with recorded penicillin allergies had higher SSI rates due to the use of suboptimal prophylactic agents. Implementing processes to address allergies resulted in successful cephalosporin administration and reduced allergic responses.
Impact of Pre-Operative Urine Cultures
Routine pre-operative urine cultures may not be necessary for non-urological surgical procedures, as they do not significantly reduce post-operative infections. Studies suggest that treating asymptomatic bacteria detected pre-operatively may not prevent post-operative infections. Understanding the limitations of pre-operative urine cultures is crucial for optimizing patient care and antibiotic stewardship efforts.
The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.
Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and more!
