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unnecessarily increases the likelihood of antibiotic resistance.
Focus on using antibiotics that show activity against bacteria that are known
to cause infections during the types of procedures you host, says Dr. Martinello.
He says it's important to base your antibiotic regimens on national guidelines,
but it's equally important to consider the types of bacteria that are causing infec-
tions at your facility, or at other healthcare facilities within your community, and
adjust your protocols accordingly.
The patient care team at Yale New Haven adjusted its antibiotic protocols
on a specialty-specific manner. For example, they administer metronidazole to
GYN patients, because metronidazole has a greater activity against anaerobic
bacteria, which is often the cause of infections in gynecologic surgery. Dr.
Martinello says the hospital is considering extending coverage of gram-nega-
tive bacteria — which include Escherichia coli and pseudomonas — for its
joint replacement patients. He says hip replacement patients are particularly
susceptible to infection because the complex procedures require manipulation
of deep tissue. Plus, says Dr. Martinello, the body has a more difficult time
fighting off infection caused by bacteria or fungus that grows on implants than
it would if the infection-causing organisms grew in native tissue. Yale New
Haven is also considering adding gentamicin to cefazolin as the standard
antibiotics administered to the majority of surgical patients in order to provide
broad prophylactic coverage against the bacteria that's causing infections seen
at the hospital.
Dr. Martinello says cefazolin is re-dosed after the initial pre-op dose at the 3-
hour mark of longer surgeries, but care teams avoid giving post-op antibiotics
whenever possible. "Studies performed over the last decade have shown limited
benefit in continuing antibiotics after surgery," he adds. "Antibiotics that don't
provide benefit only provide risk by selecting out bacteria that may be resistant
and increasing risk of antibiotic-related complications such as Clostridium dif-
ficile infection."
