Complications in Pelvic Floor Surgery: Peri operative infective complications
|
|
- Sylvia Ross
- 5 years ago
- Views:
Transcription
1 IUGA W19: 4 September 2012 Workshop notes Complications in Pelvic Floor Surgery: Peri operative infective complications A/Professor Mary O Reilly MBBS FRACP MPH Eastern Health; Faculty of Medicine, Nursing and Health Sciences, Monash University; Cabrini Health; Melbourne, Victoria, Australia. Introduction While infective complications from pelvic surgery are uncommon, they can be difficult to diagnose and manage. This session will cover perioperative infective complications associated with pelvic floor surgery including prevention, diagnosis and management in addition to an update on some of the newer multi-resistant organisms which may complicate surgery and the new and old agents now used to treat them. The discussion will also include preventing and managing the complications of the antimicrobial agents used to prevent surgical infections Topics to be covered include: Post operative sepsis Post operative haematoma The role of antibiotic irrigations Prevention including bundles and surgical antimicrobial prophylaxis Problematic Bugs Clostridium difficile Recurrent UTI ESBL gram negatives including Indian metallo-betalactamases CA- MRSA Community Acquired MRSA
2 1. An ID physicians approach to postoperative fever?infection Most common Urinary tract infection % HAI, Chest infection, IV site infection Surgical complications are less common Surgical site infection, Intra-abdominal sepsis Haematoma (Remember drug fevers) Question: Is it infection or haematoma or infected haematoma? 1.1 Haematoma Clinical Febrile but often look well despite spiking temperatures of o C No rigors May have persistent fever from time of surgery May be febrile for 7-10 days depending on size of clot Investigations: Blood cultures - negative Initial elevated WCC Elevated CRP: can be in the hundreds Imaging : Ultrasound, CT: absence of features suggesting abscess e.g. no air fluid levels, no complex echoes Management Supportive If uncertain, broad spectrum antibiotics aiming to cease when cultures are negative and diagnosis clear(er) No role for prophylactic antibiotics Risk of selection of resistant organisms Complications including antibiotic related diarrhoea Other complications including IV related infections Confuses the picture and may lead to a long unnecessary course of antimicrobials
3 1.2 Infected haematoma Clinical: associated wound infection or cellulitis, secondary fever if patient rigors, they have an infection Investigation Ultrasound, CT: complex echoes, gas, fluid levels Aspirate polymorphs, positive cultures Positive blood cultures Management Drain if possible o Ultrasound, CT drainage o?open IV/oral antimicrobials as for pelvic sepsis see below May require 2-6 weeks therapy if a large undrained collection 1.3 Pelvic sepsis Clinical: +/- Wound infection or cellulitis, Secondary fever Purulent discharge if patient rigors, they have an infection (if rapidly progressing cellulitis, crepitus, necrosis, local pain out of keeping with clinical signs consider necrotising fasciitis) Investigation Ultrasound, CT: complex echoes, gas, fluid levels Aspirate polymorphs, positive cultures Positive blood cultures
4 Management pelvis sepsis (excluding necrotising fasciitis) Drain if possible o Ultrasound, CT drainage o?open IV/oral antimicrobials as for pelvic sepsis see below ~7 days related to progress (May require 2-6 weeks therapy if a large undrained collection, follow clinically and CRP) Antimicrobial therapy for pelvic post operative sepsis Empiric treatment related to local antibiograms and local guidelines and individual patient Likely organisms Gut Staph Resistant organisms May be low virulence organisms with mesh in situ Risk of yeast infections Previous bacteriology Consider Health service MRO rates Other factors Antimicrobial Stewardship C.difficile rates ESBL rates Toxicity e.g. gentamicin Cost Agents refer to local guidelines and stewardship programs e.g Therapeutic Guidelines Australia; National Antibiotic Guidelines Malaysia, Singapore, ECCMID; local European Guidelines NHS; Local Trust guidelines; SCIP, Scotland; HICPAC (USA); IDSA:;2009 American College of Obstetricians and Gynecologists (ACOG) Australia:
5 Empiric Ampicillin, gentamicin (or 3 rd generation cephalosporin), metronidazole (minimise gentamicin use) Ticarcillin clavulanate, Piperacillin tazobactam if prolonged 3 rd generation cephalosporins plus metronidazole Quinolones plus metronidazole not recommended, reserve agents Carbapenems reserve agent Vancomycin for high prevalence MRSA Others (based on public domain guidelines) Malaysia cefotaxime or ampicillin beta lactamase inhibitor, or ciprofloxacin metronidazole Europe betalactam betalactamase inhibitors UK focus on minimising 3 rd generation cephalosporins, increased gentamicin use US broader cover including carbapenems, quinolones Duration of therapy It depends! Organism and site? associated bacteremia E.g. staph aureus bacteremia recommended 2 weeks IV then 4 week oral enterococcal bacteremia recommended 2 weeks IV Gram negative bacteremia: treat until better, May be all oral therapy or short term IV followed by oral?collection drained, partially drained or undrained?mesh?vascular involvement (very rare) (Other patient factors: prosthetic devices e.g. valve replacements; immune-suppression etc) Role of Antibiotic irrigations for management of sepsis Risks: Local reactions Hypersensitivity Induction of resistance
6 2. Prevention of peri-operative infections: Prevention of peri-operative infective complications Bundles including Antibiotic prophylaxis HICPAC, USA: NHS, UK; NHS Scotland; Australia; Antimicrobial choice: Refer to local guidelines related to procedure, risk, individual and local antibiograms 2.1 General Principles: HICPAC 2009 Administer antimicrobial prophylaxis in accordance with evidence based standards and guidelines Administer within 1 hour prior to incision *2hr for Vancomycin and fluoroquinolones Select appropriate agents on basis of surgical procedure Most common SSI pathogens for the procedure Published recommendations Remote infections-whenever possible: Identify and treat before elective operation Postpone operation until infection has resolved Do not remove hair at the operative site unless it will interfere with the operation; do not use razors If necessary, remove by clipping or by use of a depilatory agent Redose antibiotic at the 3 hr interval in procedures with duration >3hrs (* See exceptions to this recommendation in*engelmanr, et al. The Society of Thoracic Surgeons Practice Guideline Series:AntibioticProphylaxis in CardicaSurgery, Part II:AntibioticChoice. Ann Thor Surg2007;83: Adjust antimicrobial prophylaxis dose for obese patients (BMI >30) *Anderson DJ, Kaye KS, Classen D, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol2008;29 (Suppl1):S51-S Role of antimicrobial prophylaxis in mesh surgery unproven, but common practice. [ All women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence should receive a single dose of first-generation cephalosporin. (III-B) Society O &G Canada 2012] [Harmanli et al Int Urogynecol J 2012 Antibiotic prophylaxis in mid urethral slings: no benefit]
7 2.3 Gynaecological Antimicrobial prophylaxis (if indicated) Regional differences: EXAMPLES only: please see your local guidelines for recommendations for your region Hysterectomy Australia Therapeutic Guidelines Antibiotic Version (Local health service variations) Cephazolin 1g (2g if >80kg) and metronidazole 500 mg or cefoxitin 1g Malaysia National Antibiotic Guidelines Cefuroxime 1.5 G IV; alternative amoxicillin clavulanate UK Co-amoxiclav1.2g IV given at induction Cefuroxime 1.5g IV plus Metronidazole 500mg IV given at induction NHS Scotland Avoid cephalosporins, clindamycin, quinolones and co-amoxiclav wherever possible Take into account local resistance patterns e.g. >95% of MRSA isolated in Tayside are sensitive to gentamicin De-colonisation therapy prior to surgery when MRSA positive when recommended in Infection Control Policies Canada USA IDSA Cephalosporins single dose cefazolin 1-2 G or cefoxitin or cefazolin Ampicillin sulbactam for endocarditis prophylaxis In patients with beta-lactam allergy, options include clindamycin plus gentamicin or quinolone Consider the individual Allergies Renal and liver function MRO s Recent hospitalisations Recent therapy
8 General Principles for antimicrobial prophylaxis In general one dose, usually IV In general commencing up to 1 hour prior to procedure not during or after the procedure! No role for a few days of oral before (may induce resistance) No evidence for extra doses post operatively Don t use broader spectrum than recommended Difficult to treat post op if complications Call a friend! (ID physician or Microbiologist) If complex individual prophylaxis issues should be discussed with Microbiology or Infectious Diseases pre-operatively and recorded in medical notes NHS Scotland 2.4 Wound Infections If percutaneous surgery i.e. transabdominal or laparoscopic ensure no active skin lesions o Local or remote (CDC 1A) If exfoliating skin condition e.g. psoriasis, eczema; optimise preoperatively especially if inserting mesh Decolonisation MRSA carriers o In general not undertaken for Gynaecological surgery o Regional differences Questionable role of preoperative shower in gynaecological surgery? Hair removal (Cochrane 2006) o Avoid if possible o If required clipping not shaving o As close to surgery as practible IV antimicrobial prophylaxis if relevant Skin antisepsis as per guidelines o Chlorhexidine alcohol superior to povidone iodine in clean/contaminated surgery CDC: no preference Darouiche 2010: chlorhexidine superior Ref.Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH 2.5 Vaginal preparation Controversial Povidone iodine Chlorhexidine potentially toxic Sterile saline
9 2.6 Prevention of procedural associated UTI See Bundles Investigate for and treat bacteriuria pre op (close to surgery) o If recurrent UTI give pt a MSU slip ~ 5 days pre-operatively o Ensure results followed up and actioned Remove urinary catheter as soon as possible Routine surgical single dose perioperative prophylaxis may reduce UTI 3. Recurrent UTI s 3.1 Avoid chasing the cultures 3.2 Non antimicrobial therapies Topical Estrogen Role of cranberry juice 3.3 Antimicrobial agents Beneficial (Cochrane review) 6 month trial As narrow spectrum as possible Trimethoprim, Cephalexin Avoid Cotrimoxazole due to potential side effects Induces MRO s
10 4. Problematic Bugs 4.1 Clostridium difficile Hyper-virulent strain Drivers: Management Antimicrobial use Prophylaxis or therapy Cephalosporins and quinolones highest risk Prevention Minimise antimicrobial use: Antimicrobial Stewardship In general one dose for prophylaxis is adequate Choice of antimicrobial Cephalosporins higher risk than broad spectrum penicillins or aminoglycosides Early investigation and treatment as per local guidelines Cease antibiotics if possible Oral Metronidazole or oral Vancomycin first line Nasogastric, rectal Vancomycin if unable to tolerate oral Role of probiotics under investigation 4.2 Resistant gram negatives Extended spectrum beta lactamases (ESBL) gram negative organisms e.g. E.coli and Klebsiella other plasmid-mediated beta-lactamase-1 (bladha-1). Resistant to common agents including 3 rd generation cephalosporins e.g. ceftriaxone, cefotaxime May be quinolone resistant Usually susceptible to carbapenems Common in India and Asia and travellers to endemic areas New Delhi metallobeta lactamases (e.g blandm-1). Originally described in E. coli now more widespread including in V. cholerae, Resistant to common agents including 3 rd generation cephalosporins e.g. ceftriaxone, cefotaxime and carbapenems e.g. meropenem Usually no oral agent therefore require prolonged intravenous therapy Infection Control implications
11 Treatment Options: Limited, all IV, all expensive, IV Colistin IV Tigecycline (not for pseudomonas) Consider Hospital in the Home if available Prevention Antimicrobial Stewardship Infection Control in health care facilities 4.3 Community Acquired MRSA Ca MRSA, (formerly Non-multiresistant MRSA [nm MRSA]) MRSA resistant to Methicillin(Oxacillin, flucloxacillin) but often sensitive to clindamycin, doxycycline or Cotrimoxazole in addition to vancomycin Often community rather than hospital associated High virulence. Associated with recurrent boils and severe pneumonia.
Antibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationAntibiotic Prophylaxis in Spinal Surgery Antibiotic Guidelines. Contents
Antibiotic Prophylaxis in Spinal Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine Unique
More informationAntibiotic Prophylaxis Update
Antibiotic Prophylaxis Update Choosing Surgical Antimicrobial Prophylaxis Peri-Procedural Administration Surgical Prophylaxis and AMS at Epworth HealthCare Mr Glenn Valoppi Dr Trisha Peel Dr Joseph Doyle
More informationSURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES WITHIN ORTHOPAEDIC SURGERY FOR ADULT PATIENTS
SURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES WITHIN ORTHOPAEDIC SURGERY FOR ADULT PATIENTS Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if
More informationGASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT
GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT DRAFT AS CURRENTLY OUT FOR CONSULTATION BUT CAN BE UTILISED IN PRESENT FORMAT Name & Title Of Author: Date Revised: Approved by Committee/Group:
More informationTreatment of Surgical Site Infection Meeting Quality Statement 6. Prof Peter Wilson University College London Hospitals
Treatment of Surgical Site Infection Meeting Quality Statement 6 Prof Peter Wilson University College London Hospitals TEG Quality Standard 6 Treatment and effective antibiotic prescribing: People with
More informationGynaecological Surgery in Adults Surgical Antibiotic Prophylaxis
Gynaecological Surgery in Adults Surgical Antibiotic Prophylaxis Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More informationPharmacology Week 6 ANTIMICROBIAL AGENTS
Pharmacology Week 6 ANTIMICROBIAL AGENTS Mechanisms of antimicrobial action Mechanisms of antimicrobial action Bacteriostatic - Slow or stop bacterial growth, needs an immune system to finish off the microbe
More informationAntimicrobial Update. Alison MacDonald Area Antimicrobial Pharmacist NHS Highland April 2018
Antimicrobial Update Alison MacDonald Area Antimicrobial Pharmacist NHS Highland alisonc.macdonald@nhs.net April 2018 Starter Questions Setting the scene... What if antibiotics were no longer effective?
More informationTrust Guideline for the Management of: Antibiotic Prophylaxis in adults undergoing procedures in Interventional Radiology
Antibiotic Prophylaxis in adults undergoing procedures in Interventional Radiology A Clinical Guideline For use in: By: For: Division responsible for document: Key words: Interventional Radiology Prescribers
More informationPerichondritis: Source: UpToDate Ciprofloxacin 10 mg/kg/dose PO (max 500 mg/dose) BID Inpatient: Ceftazidime 50 mg/kg/dose q8 hours IV
Empiric Antibiotics for Pediatric Infections Seen in ED NOTE: Choice of empiric antibiotic therapy must take into account local pathogen frequency and resistance patterns, individual patient characteristics,
More informationPIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS
PIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS The current supply of piperacillin- tazobactam should be reserved f Microbiology / Infectious Diseases approval and f neutropenic sepsis, severe sepsis
More informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
More informationAppropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases
Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses
More informationAntibiotic prophylaxis guideline for colorectal, hepatobiliary and vascular surgery for adult patients.
Antibiotic prophylaxis guideline for colorectal, hepatobiliary and vascular surgery for adult patients. Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience,
More informationNHS Dumfries And Galloway. Surgical Prophylaxis Guidelines
NHS Dumfries And Galloway Surgical Prophylaxis Guidelines The aim of surgical prophylaxis is to reduce rates of surgical site and health-care associated infections and so reduce surgical morbidity and
More informationPRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE
PRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE Global Alliance for Infection in Surgery World Society of Emergency Surgery (WSES) and not only!! Aims - 1 Rationalize the risk of antibiotics overuse
More informationDeveloped by Kathy Wonderly RN, MSEd,CPHQ Developed: October 2009 Most recently updated: December 2014
Developed by Kathy Wonderly RN, MSEd,CPHQ Developed: October 2009 Most recently updated: December 2014 The Center for Medicare and Medicaid (CMS) is moving away from collecting data on the process of care
More informationWho should read this document 2. Key practice points 2. Background/ Scope/ Definitions 2. What is new in this version 2. Policy/Procedure/Guideline 4
Antibiotic Guidelines Antibiotic Prophylaxis in Urology Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine Unique
More informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
More informationVCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS
VCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS CARDIAC Staphylococcus aureus, S. epidermidis, except for For patients with known MRSA colonization, recommend decolonization with Antimicrobial Photodynamic
More informationAntibiotic Stewardship Program (ASP) CHRISTUS SETX
Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:
More informationNeurosurgery Antibiotic Prophylaxis Guideline
Neurosurgery Antibiotic Prophylaxis Guideline Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version
More informationInfection Comments First Line Agents Penicillin Allergy History of multiresistant. line treatment: persist for >7 days they may be
Gastrointestinal Infections Infection Comments First Line Agents Penicillin Allergy History of multiresistant Campylobacter Antibiotics not recommended. Erythromycin 250mg PO 6 Alternative to first N/A
More informationWomen s Antimicrobial Guidelines Summary
Women s Antimicrobial Guidelines Summary 1. Introduction and Who Guideline applies to This guideline has been developed to deliver safe and appropriate empirical use of antibiotics for patients at University
More information21 st Expert Committee on Selection and Use of Essential Medicines Peer Review Report Antibiotics Review
(1) Have all important studies/evidence of which you are aware been included in the application? Yes No Please provide brief comments on any relevant studies that have not been included: (2) For each of
More informationSimilar to Penicillins: -Chemically. -Mechanism of action. -Toxicity.
Similar to Penicillins: -Chemically. -Mechanism of action. -Toxicity. Cephalosporins are divided into Generations: -First generation have better activity against gram positive organisms. -Later compounds
More informationWho should read this document 2. Key practice points 2. Background/ Scope/ Definitions 2. What is new in this version 3. Policy/Procedure/Guideline 3
Antibiotic Prophylaxis in Cranial Neurosurgery Antibiotic Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): as above Authors Division: DCSS & Tertiary
More informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
More informationSHC Surgical Antimicrobial Prophylaxis Guidelines
SHC Surgical Antimicrobial Prophylaxis Guidelines I. Purpose/Background This document is based upon the 2013 consensus guidelines from American Society of Health-System Pharmacists (ASHP), the Infectious
More information1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient
1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime
More informationMulti-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED Printed copies must not be considered the definitive version
Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED 2018 Printed copies must not be considered the definitive version DOCUMENT CONTROL POLICY NO. IC-122 Policy Group Infection Control
More informationAntibiotic Usage Guidelines in Hospital
SUPPLEMENT TO JAPI december VOL. 58 51 Antibiotic Usage Guidelines in Hospital Camilla Rodrigues * Use of surveillance data information of Hospital antibiotic policy guidelines from Hinduja Hospital. The
More informationApproach to pediatric Antibiotics
Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus
More informationIntro Who should read this document 2 Key practice points 2 Background 2
Antibiotic Guidelines: Obstetric Anti-Infective Prescribing Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Kelly Alexander / Frances Garraghan
More informationAntimicrobial Prophylaxis in the Surgical Patient. M. J. Osgood
Antimicrobial Prophylaxis in the Surgical Patient M. J. Osgood Outline Definitions surgical site infection (SSI) Risk factors Wound classification Microbiology of SSIs Strategies for prevention of SSIs
More informationFelipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare
Felipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare 100% of all wounds will yield growth If you get a negative culture you something is wrong! Pseudomonas while ubiquitous does
More informationWho should read this document 2. Key practice points 2. Background/ Scope/ Definitions 2. What is new in this version 2. Policy/Procedure/Guideline 4
Antibiotic Guidelines Antibiotic Prophylaxis in Urology Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine Unique
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationHospital Acquired Infections in the Era of Antimicrobial Resistance
Hospital Acquired Infections in the Era of Antimicrobial Resistance Datuk Dr Christopher KC Lee Infectious Diseases Unit Department of Medicine Sungai Buloh Hospital Patient Story 23 Year old female admitted
More informationThe β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018
The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How
More informationAntimicrobial Prophylaxis for Surgical and Non-surgical Procedures
Antimicrobial Prophylaxis for Surgical and Non-surgical Procedures Written by: Dr Linda Jewes, Consultant Microbiologist Date: April 2016 Approved by: Drugs & Therapeutics Committee Date: September 2016
More informationPeri-operative Antibiotic Prophylaxis. 2 nd QI Cycle results Compiled by: Dr Stella Sasha
Peri-operative Antibiotic Prophylaxis 2 nd QI Cycle results Compiled by: Dr Stella Sasha 2 nd QI cycle 4 weeks (11 April 8 May) Elective MIS cases Hysterectomy +/- salpingo-oophorectomy Myomectomy Oophorectomy
More informationPrevention of surgical site infections (SSI) nosocomial infection * - Lead to prolonged hospital stay and increased coasts
Antibiotic Prophylaxis in Surgery Birgit Ross, MD Dep. of Hospital Hygiene University Hospital and Clinics, Essen Prevention of surgical site infections (SSI) - Surgical site infections account for approximately
More informationyour hospitals, your health, our priority PARC (Policy Approval and Ratification Committee) STANDARD OPERATING PROCEDURE:
STANDARD OPERATING PROCEDURE: TRUST ANTIBIOTIC TREATMENT SOP SOP NO: TW10/136 SOP 1 VERSION NO: VERSION 6.1 (JANUARY 2013) APPROVING COMMITTEE: INFECTION PREVENTION AND CONTROL COMMITTEE DATE THIS VERSION
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
More informationOther Beta - lactam Antibiotics
Other Beta - lactam Antibiotics Assistant Professor Dr. Naza M. Ali Lec 5 8 Nov 2017 Lecture outlines Other beta lactam antibiotics Other inhibitors of cell wall synthesis Other beta-lactam Antibiotics
More informationNational Antimicrobial Prescribing Survey
Indication documented Surgical prophylaxis >24 hrs Allergy mismatch Microbiology mismatch Incorrect route Incorrect dose/frequency Incorrect duration Therapeutic Guidelines Local guidelines * Non-compliant
More informationClinical Guideline. District Infectious Diseases Management. Go to Guideline. District Infectious Diseases Management CG 18_24
Clinical Guideline District Infectious Diseases Management Sites where Clinical Guideline applies All facilities This Clinical Guideline applies to: 1. Adults Yes 2. Children up to 16 years Yes 3. Neonates
More informationGUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS
Version 3.1 GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Date ratified June 2008 Updated March 2009 Review date June 2010 Ratified by Authors Consultation Evidence base Changes
More informationAntimicrobial Stewardship 101
Antimicrobial Stewardship 101 Betty P. Lee, Pharm.D. Pediatric Infectious Disease/Antimicrobial Stewardship Pharmacist Lucile Packard Children s Hospital Stanford Disclosure I have no actual or potential
More informationOBSTETRICS & GYNAECOLOGY. Penicillin G 5 million units IV ; followed by 2.5 million units 4hourly upto delivery
OBSTETRICS & GYNAECOLOGY A.OBSTETRICS Infection/Condition/likely organism Intrapartum Group B Streptococcal (GBS) infection; positive mothers Suggested treatment Preferred Penicillin G 5 million units
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Pneumonia Community Acquired Pneumonia 1) Is it pneumonia? ie new symptoms and signs of
More informationGUIDELINE FOR ANTIMICROBIAL USE IN THE ORTHOPAEDIC AND TRAUMA DEPARTMENT
GUIDELINE FOR ANTIMICROBIAL USE IN THE ORTHOPAEDIC AND TRAUMA DEPARTMENT Written by: Dr Ken. N. Agwuh, Consultant Microbiologist Mr Roger Helm, Consultant Orthopaedic Surgeon Mr T Kumar, Consultant Orthopaedic
More informationThe role of Infection Control Nurse in Prevention of Surgical Site Infection (SSI) April 2013
The role of Infection Control Nurse in Prevention of Surgical Site Infection (SSI) April 2013 Impact of SSI 2 nd common health- care associated infection (HCAI) 14-16% of HCAI Post operation SSI prolong
More informationSuper Bugs and Wonder Drugs: Protecting the One While Respecting the Many
Super Bugs and Wonder Drugs: Protecting the One While Respecting the Many Vicki Stringfellow, MSN, CPNP-AC/PC Werner Division of Pediatric Critical Care University of Kentucky Lexington, KY Disclosure
More informationDr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust
Dr Eleri Davies Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Antimicrobial stewardship What is it? Why is it important? Treatment and management of catheter-associated
More information2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
More informationAntibiotic Prophylaxis in Adult Orthopaedic Surgery. Formulary/prescribing guideline
Document type: Antibiotic Prophylaxis in Adult Orthopaedic Surgery Version: 2.0 Author (name): Author (designation): Validated by Formulary/prescribing guideline Dr Celia Chu, Dr Katy Edwards, Dr Pradeep
More information3/20/2011. Code 215 of Hammurabi: If a physician performed a major operation on
The Good Antibiotics: the Good, the Bad and the Ugly John P. Cello, MD Professor of Medicine and Surgery, University of California, San Francisco Most organisms can be readily identified by culture, special
More informationPreventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal
Preventing Multi-Drug Resistant Organism (MDRO) Infections For National Patient Safety Goal 07.03.01 2009 Methicillin Resistant Staphlococcus aureus (MRSA) About 3-8% of the population at large is a carrier
More informationMisericordia Community Hospital (MCH) Antimicrobial Stewardship Report. July December 2013 Second and Third Quarters 2014
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 213 Second and Third Quarters
More informationPOINT PREVALENCE SURVEY A tool for antibiotic stewardship in hospitals. Koen Magerman Working group Hospital Medicine
POINT PREVALENCE SURVEY A tool for antibiotic stewardship in hospitals Koen Magerman Working group Hospital Medicine Background Strategic plan By means of a point prevalence survey and internal audits
More informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report to 214 Table of Contents I. Introduction..
More informationCase 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance
Case 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance 22nd Congress of the EAHP "Hospital pharmacists catalysts for change", 22-24 March 2017, Cannes Disclosure
More informationجداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی
جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه
More information2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
More informationGive the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS
Give the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS Clinical Pharmacy Specialist, Critical Care Dell Seton Medical Center at the University of Texas and Seton Healthcare Family Clinical
More informationAntimicrobial utilization: Capital Health Region, Alberta
ANTIMICROBIAL STEWARDSHIP Antimicrobial utilization: Capital Health Region, Alberta Regionalization of health care services in Alberta began in 1994. In the Capital Health region, restructuring of seven
More informationPost-operative surgical wound infection
Med. J. Malaysia Vol. 45 No. 4 December 1990 Post-operative surgical wound infection Yasmin Abu Hanifah, MBBS, MSc. (London) Lecturer Department of Medical Microbiology, Faculty of Medicine, University
More informationProphylactic antibiotic timing and dosage. Dr. Sanjeev Singh AIMS, Kochi
Prophylactic antibiotic timing and dosage Dr. Sanjeev Singh AIMS, Kochi Meaning - Webster Medical Definition of prophylaxis plural pro phy lax es \-ˈlak-ˌsēz\play : measures designed to preserve health
More informationMedicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck!
Medicinal Chemistry 561P 2 st hour Examination May 6, 2013 NAME: KEY Good Luck! 2 MDCH 561P Exam 2 May 6, 2013 Name: KEY Grade: Fill in your scantron with the best choice for the questions below: 1. Which
More informationScottish Medicines Consortium
Scottish Medicines Consortium tigecycline 50mg vial of powder for intravenous infusion (Tygacil ) (277/06) Wyeth 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the
More informationMercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
More informationAntibacterial therapy 1. د. حامد الزعبي Dr Hamed Al-Zoubi
Antibacterial therapy 1 د. حامد الزعبي Dr Hamed Al-Zoubi ILOs Principles and terms Different categories of antibiotics Spectrum of activity and mechanism of action Resistancs Antibacterial therapy What
More informationThis is the use of antibiotics before, during and after a diagnostic, therapeutic or surgical procedure to prevent infectious complications.
Antibiotic prophylaxis in surgery CSu2 Policy Antimicrobial prophylaxis is used to reduce the incidence of post operative wound infection; patients undergoing procedures associated with high infection
More informationThe Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection
THE IRAQI POSTGRADUATE MEDICAL JOURNAL PROPHYLACTIC ANTIBIOTICS ON SURGICAL WOUND INFECTION The Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection Ahmed Hamid Jasim*, Nabeel
More informationAntimicrobial Stewardship
Antimicrobial Stewardship Report: 11 th August 2016 Issue: As part of ensuring compliance with the National Safety and Quality Health Service Standards (NSQHS), Yea & District Memorial Hospital is required
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
PAGE 1 of 3 PURPOSE To assure that DOP inmates with Soft Tissue Infections are receiving high quality Primary Care for their infections and that the risk of infecting other inmates or staff is minimized.
More informationResponsible use of antibiotics
Responsible use of antibiotics Uga Dumpis MD, PhD Department of Infectious Diseases and Infection Control Pauls Stradiņs Clinical University Hospital Challenges in the hospitals Antibiotics are still effective
More informationDisclosures. Principles of Antimicrobial Therapy. Obtaining an Accurate Diagnosis Obtain specimens PRIOR to initiating antimicrobials
Disclosures Principles of Antimicrobial Therapy None Lori A. Cox MSN, ACNP-BC, ACNPC, FCCM Penn State Hershey Medical Center Neuroscience Critical Care Unit Obtaining an Accurate Diagnosis Determine site
More informationTreatment of peritonitis in patients receiving peritoneal dialysis Antibiotic Guidelines. Contents
Treatment of peritonitis in patients receiving Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Jude Allen (Pharmacist) Additional author(s): Dr David Lewis, Dr Dimitrios Poulikakos,
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Community Acquired 1) Is it pneumonia? ie new symptoms and signs of a lower respiratory
More informationDuke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients
Duke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients PURPOSE Fever among neutropenic patients is common and a significant cause of morbidity
More informationAntimicrobial Prophylaxis in Digestive Surgery
Antimicrobial Prophylaxis in Digestive Surgery Toar JM. Lalisang, MD, PhD Digestive Surgery Division Cipto Mangunkusumo Hospital Medical Faculty Universitas Indonesia Antibiotic must be present before
More informationDiabetic Foot Infection. Dr David Orr Consultant Microbiologist Lancashire Teaching Hospitals
Diabetic Foot Infection Dr David Orr Consultant Microbiologist Lancashire Teaching Hospitals History of previous amputation [odds ratio (OR)=19.9, P=.01], Peripheral vascular disease (OR=5.5, P=.007)
More informationProtocol for exit-site care and treatment of exit-site infections in peritoneal dialysis CONTROLLED DOCUMENT
CONTROLLED DOCUMENT Protocol for exit-site care and treatment of exit-site infections in peritoneal dialysis CATEGORY: CLASSIFICATION: PURPOSE Controlled Document Number: Guideline Clinical The purpose
More informationCefuroxime 1.5gm IV and Metronidazole 500mg IV. Metronidazole 500mg IV/Ampicillin-sulbactam e 3g/Ceftriaxone 2gm. +Metronidazole 500mg/Ertapenem 1gm
SURGICAL ANTIBIOTIC PROPHYLAXIS GENERAL SURGERY* PROCEDURE RECOMMENDED AGENTS a,b Clean None None ALTERNATIVE AGENTS (If allergic to penicillin or colonized/infected with MRSA at any site) Clean with potential
More information* gender factor (male=1, female=0.85)
Usual Doses of Antimicrobials Typically Not Requiring Renal Adjustment Azithromycin 250 500 mg Q24 *Amphotericin B 1 3-5 mg/kg Q24 Clindamycin 600 900 mg Q8 Liposomal (Ambisome ) Doxycycline 100 mg Q12
More informationWho should read this document? 2. Key practice points 2. Background/ Scope/ Definitions 2. What is new in this version? 3
Neurosurgical infections (adult only) Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): as above Authors Division: DCSS & Tertiary
More informationMeasure Information Form
Release Notes: Measure Information Form Version 2.4 **NQF-NORS VOLUNTARY CONSNSUS STANARS FOR HOSPITAL CAR** Measure Information Form Measure Set: Surgical Care Improvement Project (SCIP) Set Measure I
More informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007
More informationAntimicrobial Susceptibility Patterns
Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department
More informationNational Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults
National Clinical Guideline Centre Antibiotic classifications Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults Clinical guideline 191 Appendix N 3 December 2014
More information2017 SURVEILLANCE OF SURGICAL SITES INFECTIONS FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY
Canadian Nosocomial Infection Surveillance Program 2017 SURVEILLANCE OF SURGICAL SITES INFECTIONS FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY FINAL Working Group: E. Henderson, M. John, I. Davis, S. Dunford,
More informationCommunity-Associated C. difficile Infection: Think Outside the Hospital. Maria Bye, MPH Epidemiologist May 1, 2018
Community-Associated C. difficile Infection: Think Outside the Hospital Maria Bye, MPH Epidemiologist Maria.Bye@state.mn.us 651-201-4085 May 1, 2018 Clostridium difficile Clostridium difficile Clostridium
More information** the doctor start the lecture with revising some information from the last one:
Page 1 of 7 ** the doctor start the lecture with revising some information from the last one: #penicillin G has a good susceptibility against gram(+ve), Neisseria (-ve) #mostly active against strep. (don
More informationIn an effort to help reduce surgical site infections, Surgical Services associates will be expected to observe the following guidelines:
To: Dept. of Surgery Associates From: Gloria Karr, Dir. Infection Prevention Date: May, 2012 Re: Guidelines for Infection Control in In an effort to help reduce surgical site infections, Surgical Services
More information