Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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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 closing the previous patient's incision to delays the expected start time of the case ensure the drug drips for more than an and throws off the proper timing of the hour. antibiotic administration. OSM Make a note in the patient's operative report if an airway issue, positioning difficulty or other unforeseen circumstance Ms. Rehnert (catherine.rehnert@ slhn.org) is the education specialist for patient care services and Ms. LeCoultre (marian.lecoultre@slhn.org) is nurse manager at St. Luke's University Health Network in Allentown, Pa. Targets: some gram-positive bacteria, even more Common types: amoxicillin, ampicillin, nafcillin, gram-negative species: E. coli, Proteus mirabilis, piperacillin, oxacillin and meropenem Klebsiella, Haemophilus, Moraxella and anaerobes Targets: Mainly gram-positive bacteria, and some Uses: orthopedic surgery (especially if infection is gram-negative coverage already present in bone or joint) and GYN indica- (H. pylori, E. coli, Proteus mirabilis) tions Uses: prophylaxis for GI procedures and endocarditis SELECTION GUIDE Know Your Antibiotic Classes cefadroxil Glycopeptide Targets: mainly gram-positive organisms: endogeCommon type: vancomycin Quinolones Targets: Staphylococcal and Streptococcal Common types: ciprofloxacin, species (gram-positive) as IV formulation; levofloxacin, moxifloxacin C. diff. orally Targets: broad spectrum (gram-negative bacteria Uses: high-risk surgery with identifiable risk fac- more than gram-positive) tors for MRSA infection post-operatively such as Uses: beta-lactam allergic patients, patients under- diabetes, renal disease and recent hospitalization going genitourinary, ophthalmic, GI, cardiac and (also option for penicillin/cephalosporin allergic Aminoglycosides orthopedic procedures* nous Staphylococci and Streptococci, and group Common types: gentamicin, tobramycin, A beta-hemolytic Streptococcus (shows greater kanamycin beta-lactamase resistance than penicillin) Targets: gram-negative bacteria, E. coli, Uses: Bowel surgery if used with metronidazole Klebsiella, P. aeruginosa, some gram-positive aerand orthopedic surgery (shows good penetration obes (Enterococcus) into bone and surrounding tissues) Uses: prophylaxis for GI procedures Cephalosporins: Second Generation Carbapenems patients undergoing cardiac, GYN, vascular and Common types: cefaclor, cefoxitin Common types: Ertapenem, imipenem/cilastatin * Quinolones have been associated with develop- orthopedic procedures) Targets: gram-positive bacteria and some gram- ment of serious and fatal hypoglycemia, especially and meropenem negative species: E. coli, Proteus mirabilis, Monobactam in elderly and diabetic patients, but can occur in Common type: aztreonam non-diabetic patients as well. The medications can Targets: mainly gram-negative coverage interfere with development of cartilage in patients Uses: esophageal procedures; can be used with Targets: Both gram-positive and gram-negative younger than 18 years. Klebsiella, Haemophilus, Moraxella and bacteria, and anaerobic organisms (not suited for anaerobes MRSA or P. aeruginosa) Uses: Procedures involving exposure to bowel Uses: prophylaxis of surgical site infection for anaerobes — Cathleen A. Zanghi, PharmD clindamycin for penicillin/cephalosporin allergic elective colorectal patients undergoing billiary surgery surgery Cephalosporins: Third Generation Dr. Zanghi (ca thleen.zang hi@slhn.org) is a pharmacist at St. Luke's University Health Network in Allentown, Pa. Common types: ceftriaxone, Penicillin Cephalosporins: First Generation ceftazidime Common types: cefazolin, cephalexin, and 1 5 SUPPLEMENT TO 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 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 6