Antibiotics prophylaxis in surgical patients

1. Antibiotics prophylaxis
in surgery
DEPARTMENT OF WOUND CARE AND
DIABETIC FOOT
Presenter
Dr Wali Ur Rehman

2. WHAT IS ANTIBIOTIC PROPHYLAXIS
Administration Of An Antibiotics Prior To Contamination
Of Previously Sterile Tissues .
The Use Of Antibiotics For Dirty And Contaminated
Procedure Is Not Prophylaxis...

3. GOALS OF ANTIBIOTICS PROPHYLAXIS ??
1………Reduce the incidence of surgical site infection.
2……. Minimize the effect on the patients normal bacterial
flora
3…….Minimize adverse side effect of antibiotics.
4……..Minimize the emergence of antibiotics resistance.
5………Cost effectiveness.

4. Indications
Of
Antibiotics
Prophylaxis?
?
Clean contaminated surgery.
Clean surgery with insertion of an artificial
device prosthetic material such as
hernioplasty.
Impaired immune status like morbid obesity,
poor nutrition statues poorly controlled dm.
Taking immunosuppression drug.

5. Indications
Of
Antibiotics
Prophylaxis?
?
• Patient in whom the consequences of
infection may be catastrophic e.g.
Neurosurgery, open heart surgery ,
ophthalmic surgery.

6. CONSIDERATION TO CONTINUE AS
THERAPEUTIC.
Breach of sterility during surgery
Extensive contamination during surgery.

7. Use of prophylactic
antibiotics is not a
replacement for optimal
patient preparation, good
surgical technique and
theatre environment.
But keep in mind:

8. IMPORTANCE OF ANTIBIOTICS IN
DIF.TYPES OF
OPERATIONS
CLASS OF OPERATION SSI,WITH PROPHYLAXIS WITHOUT PROPHYLAXIS
1:-CLEAN SURGERY 1-2% SAME (1-2%)
2:-CLEAN CONTAMINATED 3% 6-9%
3:-contaminated 6% 13-20%
4:-dirty 7% 40%

9. TIMING OF PROPHYLXAXIS
• The risk begin s at the time of incision so effective
tissue concentration must be reached at that time ..
• Who ………within 60 mints prior to incision .
• Cdc…..Also recommends 60 mints

10. BUT
• The duration of antibiotics prophylaxis should not be
routinely exceed 24 hrs
• 1 dose preop and 2 doses post op ie total 3 doses ..

11. MICRO-ORGANISMS IN DIFFERENT SYSTEMS
• Git-colon ….Ecoli , klebsiella ,enterobacter ,clostridia and
bacteriods
• Billiary tract …ecloi , klebsiella and clostridia
• Skin ….Staph.Aureus ,staph.Epidermidis
• Nose …staph.Aureus ,pneumoccocus ,ecoli
• Mouth and pharynx…streptoccocus and pneumoccocus
• Urinary tract….Ecoli , proteus ,

12. REDOSING OF PROPHYLAXIX
• blood loss more than 1.5 l
• more than 3-4 hrs surgery

13. SURGICAL PROPHYLAXIS IN BILLIARY TRACT
PROCEDURE
• Antimicrobial prophylaxis is not necessary in low risk
patients undergoing elective laparoscopic
cholecystectomy..
• But its recommended in pts undergoing lap. Chole who
have an increased risk of infectious complications.

14. WHAT ARE SUCH RISKS
• EMERGENCY SURGERY ,DIABETIC PT , PROLONG PROCEDURE DURATION
EXCEEDING 120 MINTS ,INTRAOPERATIVE GALL BLADDER RUPTURE ,OPEN CHOLE
, ANTICIPATED BILE SPILLAGE , NON FUNCTIONING GALLBLADDER , ACUTE
CHOLECYSTITIS.
• BECAUSE SOME OF THESE FACTORS CANNOT BE DETERMIND BEFORE SURGERY
SO ITS REASONABLE TO GIVE ONE SINGLE DOSE OF PROPHYLAXIS

15. SMALL INTESTINE PROCEDURE
• For small intestine procedure with no evidence of
obstruction , first generation cephalosporine ie
cefazoline is recommended.
• For pt
• with obstructions a first generation cephalosporine with
flagyle or second generation cephalosporine with
anaerobic activity like cefoxitin or cefotetan is the
recommended agent.

16. APPENDECTOMY PROCEDURE
• Anaerobic and aerobic gram negative enteric organisms
…
• Bacteroides fragilis is the most commonly cultured
anaerobe and ecoli ie the most frequent aerobe.
• So for uncomplicated appendicitis , the recommend
regimen is a single dose of a cephalosporine with
anaerobic activity like cefoxitin or first generation
cephalo. Plus flagyle.

17. COLORECTAL PROCEDURES
• B.Fragilis and other obligate anaerobe are the most
frequently
• Ecoli most common aerobe
• A single dose of second generation cephalosporine with
both aerobic and anaerobic activities or cefazoline plus
flagyle is recommended for colon procedures.
• In instituition where increasing resistance to fist and
second generation then can use ceftriaxone and flagyle.

21. CONCLUSION OF PROPHYLAXIS
• Prophylactic antibiotics should be given in clean surgery
with prosthetic implant
• In clean contaminated.
• Should be given within 1 hour prior to surgery.
• Minimize unnecessary use of antibiotics to avoid
resistance
• Try to use right antibiotics for right choice .

22. •THANK YOU .