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A N T I B I O T I C P R O P H Y L A X I S performance and discovered inconsistency ria in specific areas of the body, so match- UPDATED RECOMMENDATIONS in selecting the right medication was a ing the right medication to where the sur- New Antimicrobial Prophylaxis Guidelines Released major issue. The essential elements of our gery will be performed is of paramount improved antibiotic delivery program high- importance. Patients undergoing GYN pro- lighted here have kept our compliance rate cedures, for example, require different at 100% since July 2010, and we're confi- prophylaxis doses than orthopedic dent it won't slip again. patients. 1. Staff education Dr. Zanghi also informed us that cefa- A multi-society collaboration resulted in updated clinical guidelines for antimicrobial prophylaxis, including the optimal time for administering pre- and intra-operative antibiotic doses (for lengthy procedures), weightbased dosing for obese patients and breakdowns of HIGH STAKES According to the CDC, SSIs account for nearly 10% of deaths caused by hospital-acquired infections, adding $10,000 to $25,000 to the cost of caring for each affected patient. especially in the morbidly obese, serum and tissue Have a representative from your facility's zolin is effective for most clean proce- antimicrobial prophylaxis for various surgical pro- pharmacy department (or perhaps an out- dures because of its activity against cedures. Among the key ground covered by the side pharmaceutical consultant if you man- Staphylococci and Streptococci. Society of Health-System Pharmacists, the age a small surgery center) talk with the Procedures that may involve exposure to Infectious Diseases Society of America, the surgical team about the importance of bowel anaerobes, on the other hand, Surgical Infection Society and the Society for antibiotic selection and on-time adminis- require combined doses of cefazolin, Healthcare Epidemiology of America: tration. metronidazole and ertapenem. Dr. Zanghi concentrations of some drugs may differ from those in normal-weight patients. Body fat percentage is a more sensitive and precise measurement of SSI risk than body mass index. • Re-dosing. Administer prophylactic agents to ensure adequate levels remain in blood and tissue • Timing. The optimal time for administration of for the interval during which the surgical site is shared that most patients who are allergic pre-op doses is within 60 minutes of the surgical delivery process to a lack of physician and to penicillin can be treated with cefazolin incision. This is a more specific time frame than the staff knowledge about proper antibiotic because reactions are infrequent, but previously recommended "at induction of anesthe- selection. The surgical team needed to attending physicians have final say in sia." Some agents, such as fluoroquinolones and learn which antibiotics are appropriate for these situations, and the pharmacy depart- vancomycin, require administration 1 to 2 hours which surgeries, so our hospital's pharma- ment will continue to call for clarification before surgery; the administration of these agents cist Cathleen A. Zanghi, PharmD, led an if questions arise about proper dosing. should therefore begin within 120 minutes of the We linked the inconsistencies in our open. For all patients, intraoperative re-dosing is excellent presentation about choosing Staying up to date on the latest antibiotic needed to ensure adequate blood and tissue concentrations if the procedure's duration exceeds 2 half-lives of the drug or excessive blood loss occurs during the procedure. — Daniel Cook On the Web: surgical incision. • See the full multi-society report in the between the different combinations of ini- delivery regulations and guidelines should tial antibiotics based on patient character- be an ongoing goal to ensure your staff to an increased risk for SSI and the pharmacokinet- istics and surgery types (see "Know Your properly performs this important first step ics of antibiotics may be altered in obese patients, Antibiotic Classes" on page 10). in SSI prevention (see "New Antimicrobial so dosage adjustments based on body weight may Prophylaxis Guidelines Released"). Hang be warranted for these patients. In the obese, and Certain antibiotics attack harmful bacte- 1 1 SUPPLEMENT TO • Weight-based doses. Obesity has been linked American Journal of Health-System Pharmacy: tinyurl.com/bu4rm3m O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2013 • Check out key recommendations in the report's pocket guide: tinyurl.com/btjnh2z M AY 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 1 2