3. “This may even bring the end of
modern medicine as we know it. We
need to act now to make sure this
does not happen.”
Remarks at a high-level dialogue on
antimicrobial resistance with UN Member
States
Dr. Margaret Chan
New York, USA
April 2016
3
4. Core competencies for
antimicrobial prescribing
C1: Understands the patient and the patient’s clinical needs
C2: Understands treatment options and how they support the
patient’s clinical needs
C3: Works in partnership with the patient and other healthcare
professionals to develop and implement a treatment plan
C4: Communicates the treatment plan and its rationale clearly to
the patient and other health professionals
C5: Monitors and reviews the patient’s response to treatment
4
Core Competencies
5. Objectives
• Articulate the principles of antimicrobial use in surgical
prophylaxis
• Describe how key institution-specific protocols can improve
the use of antimicrobials for surgical prophylaxis
• Appreciate the importance of pre-operative dosing and limiting
prophylactic antimicrobials to the duration of the surgical
procedure.
5
10. 32 yo female s/p Caesarean delivery
Post-operative vital signs stable
Received 1st-generation cephalosporin
10 minutes after the surgical incision
Does she need further antibiotics?
10
11. Principles of antimicrobial use in
surgery
• Use when indicated
• Chose an antimicrobial active
against the most likely organisms
• Administer antimicrobials
appropriately
• Limit the duration
W
D
11
12. When is prophylaxis indicated?
Surgical category Antimicrobial
prophylaxis
Antimicrobial
treatment
Clean
Clean-contaminated
Contaminated
Infected
12
13. When is prophylaxis indicated?
Surgical category Antimicrobial
prophylaxis
Antimicrobial
treatment
Clean
Clean-contaminated
Contaminated
Infected
13
14. When is prophylaxis indicated?
Surgical category Antimicrobial
prophylaxis
Antimicrobial
treatment
Clean
Clean-contaminated
Contaminated
Infected
14
15. Which agent should you choose?
Surgical
category
Prophylaxis Likely
pathogens
Spectrum of
coverage
Clean Gram-
positives, esp
GPCs
Skin flora including
staphylococci
Clean-
contaminated
Gram-
negative
bacilli and
enterococci
Enterics/GU
dictated by site
15
21. Return to Clinical Case 1
Subsequent evaluation
Initial evaluation
Clinical
assessment
Diagnostic
work-up
Patient
education
Therapeutic
decisions
Modify
antimicrobials
Data
review
Clinical
re-assessment
21
Antimicrobial administered AFTER incision
22. Duration of antimicrobials?
• additional post-operative doses
do not further decrease SSI risk
• Limiting duration of
antimicrobials is important in
reducing emergence of AMR
22
23. Other risk factors for SSIs
• infection control practices
• pre-operative preparation
• duration of the procedure
• surgeon technique
Extrinsic/system
factors
23
24. Other risk factors for SSIs
• co-morbid conditions
• skin preparation
• glucose control
• temperature
Intrinsic/patient
factors
24
27. Review: Antimicrobial Surgical Prophylaxis
Drug
Dose
Duration
Route
prescription
.............
.............
.............
Use prophylaxis when indicated.
27
28. Review: Antimicrobial Surgical Prophylaxis
Drug
Dose
Duration
Route
prescription
.............
.............
.............
Chose an antimicrobial active
against likely organisms
28
29. Review: Antimicrobial Surgical Prophylaxis
Drug
Dose
Duration
Route
prescription
.............
.............
.............
Administer antimicrobials
appropriately and limit
duration
29
30. Review: Antimicrobial Surgical Prophylaxis
Drug
Dose
Duration
Route
prescription
.............
.............
.............
Work to prevent SSIs is
critical for patient care and
requires a collaborative effort.
30
