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39 Cards in this Set

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  • Back
What is the definition of antibiotic prophylaxis?
Giving antibiotics before contamination or infection
Antibiotic prophylaxis is an empirical choice of _________.
Agent- don't want to pick one that will cause resistance
What is the goal of antibacterial prophylaxis?
Maintain inhibitory antimicrobial concentrations at incision site for duration of surgery
*What is an acceptable postoperative infection rate for small animal clean wounds?
5% infection rate
*What is an acceptable postoperative infection rate for small animal clean-contaminated wounds?
12%
*What is an acceptable postoperative infection rate for a small animal contaminated/ dirty wound?
10%
How can antimicrobial associated complications be minimized?
-With little change in patient microbial flora
-Reduction in development of resistant microbial flora in hospital / staff
When do you want to administer prophylatic antibiotics for a surgery?
at least 30 minutes prior to surgical incision
-No greater than 60 minutes prior to surgical incision
Should you administer antibiotics if its been 3 hours post-op? Why or why not?
No, if its been 3-6 hours post-op it doesn't help so don't give
Why is it so important for surgeons to wear facemasks?
Because MRSA can reside in our noses
Why is the timing of prophylactic antibiotics so important?
Must maintain adequate concentrations throughout the surgery (>MIC for expected pathogen)
When should prophylactic antiobitics be re-administered?
At 1-2 times the elimination half-life of the drug
Is it really necessary to administer prophylctic antibiotics?
Yes, appropriately administered antibiotic prophylaxis reduces chance of surgical site infection 6-7 fold
-Humans: regardless of type of surgery, ALL have reduced infections w/ prophylaxis
What bacteria are targeted by cefazolin when you give 2 mg/kg every 3 hours?
Suppresses 90% of Staphylococcus and E. coli throughout the contamination period
How often is cefazolin given for an orthopedic surgery? Soft tissue surgery?
-Ortho is every 90 min
-Soft is every 120 min
-We want to do better than 90% reduction
What is the half life of cefazolin?
48 minutes
You forget to re-administer an antibiotic and it's been 3 hours since the initial dose. Should you still give the antibiotic?
Yes, if given 3 hours after initial dose it still has an impact so give it
How long can you administer antibiotics following surgery?
Can continue up to 24 hours following surgery but NOT longer or may increase chance of infection
True or false. Cefazolin can cause hypotension in healthy dogs when under anesthesia.
False, Cefazolin has no effect on BP of dogs while under anesthesia as long as HEALTHY!
What is the mechanism of action of cefazolin?
Alters bacterial cell wall formation= gram positive organisms i.e. staph
_________ (antimicrobial) rapidly reaches therapeutic concentrations following IV administration.
Ampicillin
What are the side effects of ampicillin? (2)
1) trend for this drug to cause decreases in systolic, mean and diastolic blood pressure **why Baltzer prefers cefazolin
2) Hypersensitivity reactions can occur: ranges from anaphylaxis to cutaneous reactions
True or false. Ampicillin has some anaerobic activity so is a better choice for regions with poor circulation.
True
What type of antibiotic is cefoxitin?
3rd generation (some say second) cephalosporin
What is the spectrum of activity of cefoxitin?
Gram negative, some gram + spectrum
-if think gram negative or anaerobe think this*
What prophylactic antibiotic should you use when you're trying to target E. coli?
Cefoxitin
What are 4 surgeries where cefoxitin is the prophylactic antimicrobial of choice?
1) Cardiopulmonary surgery
2) Small intestinal surgery
3) Colorectal and liver/ biliary surgery
4) Urogenital surgery
What are 6 patient-associated determinants of an animal's predisposition to surgical site infections?
1) Extremes of age
-often drop body temp and get infection
2) Morbid obesity (dogs NOT cats)
3) American society of anesthesiologists score
-increasing score= more compromised patient= greater risk
4) Prolonged preoperative hospitalization
-more likely to be colonized by resistant bacteria the longer in hospital
5) Removal of hair the day before surgery
-If bathed or clipped more than 24 h prior to surgery then definitely increases risk because changes normal flora of skin
6) Preoperative antibiotics (+/-)
-If give antibiotics greater than 1 hours prior to surgery= increased risk of resistance
How does the duration of a surgery affect the rate of infection?
Double the risk of infection ~ every 70 minutes of surgery time
How does the duration of anesthesia affect the rate of infection? Why?
30% increase in risk of infection for every additional hour of anesthesia
-hypothermia, hypotension, hypoxia in tissues
Why is it important to minimize the number of people in the surgery room?
Risk of infection for each additional person in surgery suite, risk of infection is 1.3x higher
How is surgical infection minimized in the surgery room at OSU?
Shut doors when operating, every hour there are 10 pull air exchanges
What are 2 types of surgery that should definitely have a limited number of people in the surgery suite?
-Cardiovascular
-Joint replacement
What should you do whenever performing a dirty surgery?
Culture and sensitivity- ALWAYS DO SENSITIVITY
How much more likely is an infection at the surgery site when working with a dirty wound?
5.5x increased risk of infection at surgery site
To move a patient to an ICU or not is a difficult decision to make. What are 3 reasons doctors are hesitant to put patients in the ICU?
1) 20% nosocomial infections occur in ICU
2) Surgical ICU patients at greatest risk of developing a nosocomial infection
3) Multiresistant organisms through invasive devices
-e.g. can't leave any catheter in for longer than 3 days
How common is infection in animals with a drain?
Very common, drains reduce # of organisms needed to establish infection by 10,000x - why she sends them home w/ penrose to prevent resistant infection or use a jackson pratt in ICU that is closed off
Why does Dr. Baltzer refuse to use cold sterile?
There are fungal organisms in the cold sterile
Once an implant is infected, can you treat with antibiotics?
No, have to remove implant because cannot penetrate the biofilm with antibiotics