Antimicrobial Therapy Case Studies

Surgical procedures lead to contamination of previously sterile tissues or fluids, surgical prophylactic antimicrobial therapy (SAP) is an initial administration of short course of an antimicrobial agent before the surgery to prevent development of infection , SSI is 3rd most common nosocomial infection in US acute-care hospitals (14-16%),Complicates 5% of surgical cases overall, Increases hospital length of stay by approximately 10 days ,Increases readmissions to hospital ,Increases morbidity, Increases cost.
Criteria for defining SSIs:

 The Classification of SSI according to time; 1) Early SSI is Infection presents within 30 days of procedure, 2) Intermediate SSI Occurs between one and three months, 3) Late SSI Presents more than three months after surgery
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 Factors Associated with Increased Risk of SSI; Systemic factors:
 Insertion of Prosthetic Implants, Recent surgery, Corticosteroid use, Diabetes AND obesity, Extremes of age, Malnutrition, Massive transfusion, Multiple (3 or more) preoperative co morbid medical diagnoses, Duration of Surgery: Duration of surgery is positively associated with risk of site infection, altered immune system and Smoking.
 Factors Associated with Increased Risk of SSI; Local factors:
Contamination of instruments, inadequate antibiotic prophylaxis, prolonged procedure, Site and complexity of procedure, Shaving the site vs. clipping, Infection at remote site not treated prior to surgery, improper skin preparation, environment of the room (ventilation, sterilization)
 Microbiology of SSI, five most common pathogens; S. aureus
Enterococci, Coagulase-negative staphylococci, E. coli, Pseudomonas aeruginosa

Surgical Antimicrobial