This document discusses surgical site infections (SSIs) and the use of prophylactic antibiotics. It begins by defining different types of surgical procedures and wounds based on cleanliness and levels of contamination. It then covers appropriate use of prophylactic versus therapeutic antibiotics. Key points include administering prophylactic antibiotics shortly before incision to achieve optimal tissue levels, and using narrow-spectrum agents like cefazolin in most cases. Risk factors for SSI and strategies to prevent infection during and after surgery are also outlined. The document concludes by examining prophylactic antibiotic use in various obstetric procedures.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
MANAGEMENT OF PRETERM PROM ON INDUCTION OF LABOUR Lifecare Centre
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
Dr. Sharda Jain
Dr. jyoti Bhasker
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
MANAGEMENT OF PRETERM PROM ON INDUCTION OF LABOUR Lifecare Centre
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
Dr. Sharda Jain
Dr. jyoti Bhasker
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Adaptation and Implementation of Evidence-Based Clinical Practice Guidelines for Antibiotic Prophylaxis in Surgery in King Saud University Hospitals in Riyadh, Saudi Arabia
Guidelines For Antibiotic Use by doctor SaleemMuhammad Saleem
Antibiotic guidelines in surgery,
especially antibiotic prophylaxis.
Prophylactic antibiotics in general surgery, cardiothoracic, vascular, orthopedic,neurosurgery,
Classification of wounds.
Guidelines of prophylactic antibiotics
By doctor Saleem
https://www.saleemplasticsurgeon.com/
AMNIOINFUSION
MARCO VILLA
La amnioinfusión intenta prevenir o aliviar la compresión del cordón umbilical durante el trabajo de parto por medio de la infusión de una solución en la cavidad uterina
Mediante esta técnica se pretende diluir el meconio existente en la cavidad amniótica y evitar las compresiones de cordón y en consecuencia la acidosis del feto que predispone a la aspiración de meconio
Descrita por primera vez en 1976
Aceptada desde 1983
FUNCIONES DEL lA
Protección contra traumas
Protección del cordón umbilical a la compresión
Propiedades antibacterianas
Reservorio de fluidos y nutrientes para el feto
Permite el adecuado desarrollo de los sistemas respiratorios, muscoloesqueletico y gastrointestinal del feto.
Pacientes candidatas
Embarazos complicados con oligoamnios
Aumento del LA provee beneficio diagnostio y/o terapoeutico
indicaciones
Presencia de desaceleraciones variables severas
Presencia en el LA de Meconio Espeso
Dilución del meconio y descompresión del cordón
Útil si solo se acompaña de desaceleraciones variables
Reducción de la tasa de cesáreas por monitorización intraparto sospechosa de sufrimiento fetal (compresión de cordón)
Desaceleraciones Variables
Patrón Fetal mas frecuente
Definido como un patrón variable de FCF
Técnica de amnioinfusiónVía Transcervical
Preferida ya que no requiere US y permite instilaciones repetidas
Solución Salina (0,9%) o Ringer Lactato se instila a través de un catéter Suero
Ringer Lactato puede alterar electrolitos fetales;
no usar de rutina Protocolos recomiendan bolo inicial de 250 a 1000 mL a una tasa de 10-15 mL/min, seguido de por infusión continua de 100-200mL/hr.
No es necesario entibiar sueros
Mejorar visión en evaluación ultrasonográfica fetal
Tasa de visualización estructuras fetales mejora de 50 a 77%
Un estudio muestra que el diagnóstico etiológico se modificó en un 13% luego de amnioinfusión(1)
Ayuda a versión externa
Prevención y tratamiento de corioamnionitis en RPM
No hay estudios aleatorizados de buen diseño que evalúen efecto de amnioinfusión en RPM
Beneficios propuestos Æ Aumentar latencia, reducción de hipoplasia pulmonar, reducción de infecciones
Técnica de amnioinfusión Vía Transabdominal
Procedimiento similar a amniocentesis pero se instila líquido
Bajo visión US ubicar bolsillo de LA y puncionar con aguja 20 Ga
Infundir fluido, habitualmente entre 100 y 1000 mL
Infusión con jeringa, ya sea manualmente o con bomba
Instilar lo mínimo necesario según el objetivo de la amnioinfusión
contraindicaciones
Sospecha de corioamnionitis
Polihidramnios
Hipertonía uterina
Presentaciones fetales anómalas
Gestación múltiple
Existencia de placenta previa
GRACIAS
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
3. prophylactic use of Anti-microbial agentsJagirPatel3
Prophylactic: A preventive measure. The word comes from the Greek for "an advance guard," an apt term for a measure taken to fend off a disease or another unwanted consequence
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. Clean
No inflammation;
respiratory,
gastrointestinal,
genitourinary
tract or
oropharyngeal
cavity not
entered.
Clean-
contaminated
respiratory,
gastrointestinal,
genitourinary
tract or
oropharyngeal
cavity entered
but without
significant
spillage.
Contaminated
Acute
inflammation
(without pus) or
visible
contamination of
the wound
Dirty
Pus, previous
perforated viscous, or
compound/open
injuries >4 h old
Aboubakr Elnashar
5. Antibiotics
I. Prophylactic are applied to
1. Elective operations in the clean, clean-contaminated or
contaminated categories.
2. Emergency operations in the clean & clean-contaminated
operations e.g. emergency CS.
II. Therapeutic are applied to:
Emergency operations with contaminated or dirty wounds
Aboubakr Elnashar
7. Microorganisms
Source:
1. Skin
2. Vagina .
Types:
1. Usually aerobic gram-positive cocci:
staphylococci
2. Fecal flora: anaerobic bacteria, gram-negative
anaerobes
when incisions are made near the perineum or
groin.
Aboubakr Elnashar
8. Incidence
Depends upon:
Type of surgery
Patient risk factors &
Hospital antimicrobial practices
Most common surgical complication
5 % of operations
70% of nosocomial infections
Aboubakr Elnashar
11. Prediction
1. Disease: The American Society of Anesthesiologists
Physical statusASA
score
Normal healthy1
Mild systemic
disease
2
Severe systemic
disease
3
Incapacitating4 Aboubakr Elnashar
12. 2. Duration of surgery:
Prolonged= lasted >75th percentile for the operation
Risk index
0: no risk factor
1: one risk factor
2: both risk factors
210Operation
5.4%2.3%1%Clean
9.5%4%2.1%Clean-
contaminated
13.2%6.8%3.4%Contaminated
Aboubakr Elnashar
13. Prevention
Before:
Remove hair by clipping, not shaving, immediately
before operation
Aseptic technique by operating room team
Aboubakr Elnashar
14. During
• Limit sutures and ligatures
• Monofilament sutures
• Closed suction rather than open drainage; use no
drainage if possible.
• Meticulous skin closure.
• High intraoperative and postoperative inspired oxygen.
• Normothermia during operation
Aboubakr Elnashar
16. History
Richards (1943): Use of sulpha decreased infectious
morbidity
Burke (1961): Penicillin reduced skin infection & put
the scientific bases
Ledger et al(1975): Guidelines for prophylactic
antibiotics
Aboubakr Elnashar
17. Definition
Use of antibiotics before contamination or infection.
Peri-operative &/or intra-operative administration of
antibiotics to reduce the risk of SSI
Aboubakr Elnashar
18. Objectives
Reduce incidence of SSI
Reduce the effect of antibiotics on the normal
bacterial flora
Reduce adverse effects
1. Use effective & appropriate antibiotics.
2. Minimal change in host defenses.
3. Augment host defense mechanisms at the time of
bacterial invasion, thereby decreasing the size of the
inoculum.
Prophylactic antibiotics is an adjunct to and not a
substitute for good surgical technique.
Aboubakr Elnashar
20. Risks
Allergic reactions (from minor skin rashes to
anaphylaxis)
Pseudomembranous colitis
Diarrhea: 3-30%
Induction of bacterial resistance {prolonged use}.
Repeated doses are not recommended
Nausea, vomiting, and/or abdominal pain
Uncommon & rarely serious with single dose therapy
Aboubakr Elnashar
21. Administration
1. Type
An appropriate prophylactic antibiotic (Hemsel, 1991):
1. Effective against the common microorganisms
anticipated to cause infection.
Need not eradicate every potential pathogen.
Not be routinely used for treatment of serious
infections.
2. No adverse effect on the microbial flora
3. Adequate local tissue levels.
4. Minimal side effects.
5. Inexpensive.
6. Be administered for short duration
Aboubakr Elnashar
22. Cephalosporins
Drug of choice for most operative procedures
{Broad antimicrobial spectrum
Low allergic reaction
Low side effects}
Cefazolin 1g is the most commonly used agent
{Long ½ life 1.8 h
Low cost
Equivalent to other cephalosporins}
Aboubakr Elnashar
23. Agents not recommended for prophylaxis
3rd generation cephalosporins (Cefotaxime,
Ceftriaxone, Cefoperazone, Ceftazidime or
Ceftizoxime)
4th generation cephalosporins: e.g. cefepime
Why :
Expensive
Some are less active than 1ST generation against
staphylococci
Non-optimal spectrum of action (activity against
organisms not commonly encountered in elective
surgery)
Widespread use for prophylaxis encourages
emergence of resistance
Aboubakr Elnashar
24. Patients with penicillin allergy are at increased risk
of allergy to beta-lactam antibiotics.
An alternative:
Clindamycin, IV, 150 mg 6 hourly for 2–3 doses
(ACOG,2001)
Aboubakr Elnashar
25. 2. Time:
{Only a narrow window of antimicrobial effectiveness}:
antibiotics be administered shortly before or at the
time of bacterial inoculation (when the incision is
made, the vagina is entered, or the pedicles are
clamped).
A delay of only 3 h: ineffective prophylaxis.
Preoperatively (ideally within 30 min of induction of
anesthesia or immediately before) or
During the procedure {Tissue levels should peak when
the knife goes in}
During CS: prophylaxis should be delayed until the
cord is clamped {prevent the drug reaching the
neonate}.
Aboubakr Elnashar
26. Infection RateTiming of antibiotics
3.8%2-24 h before surgery
0.6%0-2 h before surgery
1.4%0-3 h after surgery
3.3%3-24 h after surgery
Classen et al(1992)
Aboubakr Elnashar
28. 4. Dose & duration:
Single dose
Same therapeutic one, governed by the patient's
weight.
e.g Cephalosporin (Cefazolin)
<= 70 kg: 1 g
>70 kg: 2 g
Aboubakr Elnashar
29. Additional intra-operative dose only
when:
* long procedures (> 2-3 h)
* high blood loss (>1500 ml)
Keep post-operative doses to a
minimum
Further doses Up to 48 h for selected
procedures
{Operative doses adequate for most
procedures}
Aboubakr Elnashar
31. • Highly recommended:
Prophylaxis unequivocally reduces major morbidity,
reduces hospital costs and is likely to decrease overall
consumption of antibiotics
• Recommended:
Prophylaxis reduces short-term morbidity but there are
no RCTs that prove that prophylaxis reduces the risk
of mortality or long-term morbidity. However,
prophylaxis is highly likely to reduce major morbidity,
reduce hospital costs and may decrease overall
consumption of antibiotics
Aboubakr Elnashar
32. • Recommended but local policy makers may
identify exceptions:
Prophylaxis is recommended for all patients, but local
policy makers may wish to identify exceptions, as
prophylaxis may not reduce hospital costs and could
increase consumption of antibiotics, especially if given
to patients at low risk of infection.
• Not recommended:
Prophylaxis has not been proven to be clinically effective
and as the consequences of infection are short-term
morbidity, it is likely to increase hospital antibiotic
consumption for little clinical benefit.
Aboubakr Elnashar
34. 1. CS
A. High risk :
Membrane rupture
labor
Inadequate preoperative cleansing.
Duration > one h
high blood loss.
{Reduce:
postpartum endometritis
wound infection
febrile morbidity,
UTI}
•All high-risk patients should receive prophylaxis with
narrow-spectrum antibiotics such as cephalosporin
(ACOG,2003) . Aboubakr Elnashar
35. B. Low risk:
Although the evidence is inconclusive, prophylactic antibiotics are
recommended (ACOG,2003).
Aboubakr Elnashar
36. 1st & 2nd generation cephalosporins and Augmentin
have similar efficacy.
Despite the theoretic need to cover gram-negative &
anaerobic organisms, studies have not demonstrated
a superior result with broad-spectrum antibiotics
compared with 1st & 2nd generation cephalosporins
(The Cochrane Library, 2004)
Aboubakr Elnashar
37. •Both ampicillin & 1st generation cephalosporins have
similar efficacy
•A multiple dose regimen for prophylaxis appears to offer
no added benefit over a single dose regimen
•Systemic & lavage routes of administration appear to
have no difference in effect.
(Hopkins L, Smaill F. The Cochrane Library ,Issue 3,
2004)
Aboubakr Elnashar
38. Elective & non-elective
{The reduction of endometritis by 2/3 to 3/4 &
decrease wound infections}: justifies prophylactic
antibiotics (Hopkins L, Smaill F. The Cochrane Library ,Issue 3,
2004)
Aboubakr Elnashar
39. 2. Operative vaginal delivery (vacuum or forceps)
{Reduction in endomyometritis but not reach statistical
significance (the relative risk reduction was 93%).
The data were too few and of insufficient quality} to make
any recommendations. (Liabsuetrakul et al. Cochrane Review ,2004).
Aboubakr Elnashar
41. •Uncomplicated delivery:
prophylaxis for bacterial endocarditis is optional.
•Complicated delivery by intra-amniotic
infection: Prophylactic antibiotics are
recommended
Given shortly before delivery (within 30 min) &
should not be given for more than 6-8 h.
Aboubakr Elnashar
42. • Ampicillin, 2 g IM or IV, plus
Gentamicin, 1.5 mg/ kg (not to exceed 120 mg);
6 hours later, ampicillin, 1 g IM/IV, or amoxicillin, 1 g
orally
• Patients allergic to ampicllin / amoxicillin
Vancomycin, 1 g IV over 1-2 h, plus
Gentamicin, 1.5 mg/ kg IV/IM (ACOG,2001)
Aboubakr Elnashar
43. 4. Preterm labor with intact membranes
{Reduction in maternal infection
No benefit or harm for neonatal outcomes
Concerns about increased neonatal mortality for
those who received antibiotics}.
This treatment cannot be currently recommended
for routine practice. (King J, Flenady V. The Cochrane Library,
Issue 3, 2004).
Aboubakr Elnashar
44. 5. Premature rupture of membranes:
•{Reduction in:
chorioamnionitis
numbers of babies born within 48 h & 7 d.
Neonatal morbidity: neonatal infection, use of surfactant, oxygen
therapy, and abnormal cerebral ultrasound scan
Prolonged latency does not necessarily result in improved neonatal
outcomes.
Concern about resistant bacteria}: assess the risks & benefits for
each patient (ACOG,2003).
Aboubakr Elnashar
45. 6. Prelabour rupture of membranes at or near
term:
{Significant reduction in maternal infectious morbidity
(chorioamnionitis or endometritis).
No statistically significant differences in outcomes of
neonatal morbidity} (Flenady, King; 2004, Cochrane library):
Routine use of antibiotics in pPROM.
Co-amoxiclav should be avoided {increased risk of
neonatal necrotising enterocolitis}.
Erythromycin is a better choice (Kenyon S, Boulvain M, Neilson
J. The Cochrane Library, Issue 3, 2004).
Aboubakr Elnashar
46. 7. In the 2nd or 3rd trimester:
•In unselected women:
reduction in Prelabor ROM.
•Previous PTL:
Reduction of low birth wt & postpartum endometritis.
•Previous PTL & bacterial vaginosis:
Reduction in PTL
•Previous PTL & without bacterial vaginosis:
No reduction in PTL
Aboubakr Elnashar
47. Emmanuel Bujold,
The Effect of Second-Trimester Antibiotic Therapy on the
Rate of Preterm Birth”, is a systematic review involving
over 1800 women deemed at a higher risk for preterm
delivery, comparing the rate of preterm birth between
those given antibiotics and those given placebo.
Clindamycin or antibiotics belonging to a group called
macrolides during their second trimester were less likely
to undergo preterm labour than those given a placebo.
Metronidazole were more likely to undergo preterm
labour than those given placebo. metronidazole should
be avoided for higher risk women in the second trimester
of pregnancy.
Aboubakr Elnashar
48. •Vaginal antibiotic prophylaxis:
No prevention of infectious pregnancy outcomes & a
possibility of adverse effects such as neonatal sepsis
Antibiotic prophylaxis given during 2nd or 3rd trimester
reduces the risk of prelabour ROM when given routinely.
Beneficial effects on birth wt & the risk of postpartum
endometritis were seen for high risk women (Thinkhamrop et
al, 2004, Cochrane library)
Aboubakr Elnashar
49. 8. Asymptomatic bacteriuria
•Clearing asymptomatic bacteriuria.
{Reduction in the incidence of: preterm delivery
low birth weight babies
Pyelonephritis}
(Smaill F. The Cochrane Library, Issue 3, 2004).
Aboubakr Elnashar
50. 9. Incomplete abortion.
{No differences in postabortal infection rates
with routine prophylaxis or control.
No enough evidence to evaluate a policy of
routine antibiotic prophylaxis to women with
incomplete abortion}.
(May et al, The Cochrane Library, Issue 3, 2004).
Aboubakr Elnashar
51. 10. Cervical cerclage (prophylactic
or emergency)
Evidence is insufficient to recommend
antibiotic prophylaxis (ACOG,2003).
Aboubakr Elnashar
53. 1. Hysterectomy: abdominal, vaginal,
laparoscopically assisted
{Bacterial vaginosis is a risk factor for SSI after
hysterectomy:
Metronidazole for at least 4 days, beginning just
before surgery, significantly reduces vaginal
cuff infection in patients with abnormal flora.
Aboubakr Elnashar
54. Single dose of antibiotics (ACOG, 2006).
No particular regimen to be superior to any other.
Cefazolin 1-2 g single dose, iv
Cefotoxin 2 g single dose, iv
Metronidazole 1g IV single dose
Tinidazole 2 g single oral dose (4-12 h before
surgery)
Aboubakr Elnashar
55. 2. Laparoscopy and Laparotomy:
{do not breach surfaces colonized with vaginal
bacteria
infections more often result from contamination
with skin bacteria.
No studies recommend antibiotic prophylaxis in
abdominal surgery that does not involve vaginal
or intestinal procedures}:
Antibiotic prophylaxis is not indicated for
diagnostic laparoscopy.
Aboubakr Elnashar
56. 3. HSG:
{Postoperative PID is an uncommon but potentially
serious complication.
Patients with dilated fallopian tubes are at greater risk}.
Antibiotic prophylaxis is not recommended with no
history of pelvic infection.
Dilated fallopian tubes: 100 mg of doxycycline twice
daily for 5 d.
History of pelvic infection: doxycycline before the
procedure & continued if dilated fallopian tubes are
found.
Aboubakr Elnashar
57. 4. Sonohysterography
{Rates of postprocedure infection are low.
The risks are similar to those of HSG}:
Same considerations
Aboubakr Elnashar
58. 5. Hysteroscopy
{Infectious complications after
hysteroscopic surgery are uncommon (0.18
to 1.5%).
Amoxicillin/clavulanate (Augmentin): no
significant difference in postoperative
infection}.
ACOG does not recommend routine
antibiotic prophylaxis
Aboubakr Elnashar
59. 6. IUD Insertion
{Most of IUD-related infection occurs in the first few
weeks to months after insertion: contamination of the
endometrial cavity during the procedure is the infecting
mechanism.
PID is uncommon after IUD insertion regardless of
whether antibiotic prophylaxis is used.
A Cochrane review:
doxycycline (Vibramycin) or azithromycin (Zithromax)
before IUD insertion confers little benefit.
ACOG:
no benefit with negative screening results for gonorrhea
& chlamydia.
Aboubakr Elnashar
61. 8. Surgical Abortion/D&C
{periabortal antibiotics had a 42% overall
decreased risk of infection}.
ACOG: antibiotic prophylaxis is effective,
regardless of risk.
Doxycycline: 100 mg orally 1 h before procedure
& 200 mg after procedure
Metronidazole: 500 mg orally twice daily for 5 d
Aboubakr Elnashar
62. 9. Preoperative Bowel Preparation
Surgery that may involve the bowel: 1.
Mechanical bowel preparation without
oral antibiotics and
2. Broad-spectrum parenteral antibiotic
(Cefoxitin) immediately before surgery.
Aboubakr Elnashar
63. 10. Endocarditis Prophylaxis
Recommended
High-Risk Category
Prosthetic cardiac valves
Previous bacterial endocarditis
Complex cyanotic congenital
heart disease
Surgically constructed systemic
pulmonary shunts or conduits
Moderate-Risk
Category
Most other congenital
cardiac malformations (other
than those listed above &
below)
Acquired valvar dysfunction
(eg, rheumatic heart disease)
Hypertrophic
cardiomyopathy
Mitral valve prolapse with
valvar regurgitation,
thickened leaflets, or both
Aboubakr Elnashar
64. Negligible-Risk Category (Risk No GreaterThan That of the
General Population)
Isolated secundum atrial septum defect
Surgical repair of atrial septal defect, ventricular septal defect,
or patent ductus arteriosus (without residua beyond 6 m)
Previous coronary artery bypass graft surgery
Mitral valve prolapse without valvar regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki syndrome without valvar dysfunction
Previous rheumatic fever without valvar dysfunction
Cardiac pacemakers (intravascular and epicardial) & implanted
defibrillators
Aboubakr Elnashar
65. Endocarditis Prophylaxis by Surgical Procedure
Endocarditis Prophylaxis Recommended
Gastrointestinal Tract*
Surgical operations that involve intestinal mucosa
Genitourinary Tract
Cystoscopy
Urethral dilation
Other genitourinary procedures only in presence of
infection
*Prophylaxis is recommended for high-risk patients;
optional for medium-risk patients.
Aboubakr Elnashar
66. Endocarditis Prophylaxis Not Recommended
Genitourinary Tract
Vaginal hysterectomy**
Urethral Catheterization
Uterine Dilation and Curettage
Therapeutic Abortion
Sterilization Procedures
Insertion or Removal of IUCD
**Prophylaxis is optional for high-risk patients.
Aboubakr Elnashar
70. The following recommendations and
conclusions are based on good and
consistent scientific evidence (Level A)
•Patients undergoing abdominal or vaginal hysterectomy
should receive single-dose antimicrobial prophylaxis.
•PID complicating IUD insertion is uncommon. The cost-
effectiveness of screening for gonorrhea and chlamydia
before insertion is unclear; in women screened and
found to be negative, prophylactic antibiotics appear to
provide no benefit.
•Antibiotic prophylaxis is indicated for suction curettage
abortion.
Aboubakr Elnashar
71. •Antibiotic prophylaxis is indicated for suction
curettage abortion.
•Appropriate prophylaxis for women undergoing
surgery that may involve the bowel includes a
mechanical bowel preparation without oral
antibiotics and the use of a broad-spectrum
parenteral antibiotic, given immediately
preoperatively.
•Antibiotic prophylaxis is not recommended in
patients undergoing diagnostic laparoscopy.
Aboubakr Elnashar
72. The following recommendations and
conclusions are based on limited or
inconsistent scientific evidence (Level B):
• In patients with no history of pelvic infection, HSG can
be performed without prophylactic antibiotics. If HSG
demonstrates dilated fallopian tubes, antibiotic
prophylaxis should be given to reduce the incidence of
post-HSG PID.
•Routine antibiotic prophylaxis is not recommended in
patients undergoing hysteroscopic surgery.
Aboubakr Elnashar
73. •Cephalosporin antibiotics may be used for
antimicrobial prophylaxis in women with a
history of penicillin allergy not manifested by
an immediate hypersensitivity reaction.
•Patients found to have preoperative
bacterial vaginosis should be treated before
surgery.
Aboubakr Elnashar
74. The following recommendations and
conclusions are based primarily on
consensus and expert opinion (Level C):
•Antibiotic prophylaxis is not recommended in
patients undergoing exploratory laparotomy.
•Use of antibiotic prophylaxis with saline infusion
US should be based on clinical considerations,
including individual risk factors.
•Patients with high- and moderate-risk structural
cardiac defects undergoing certain surgical
procedures may benefit from endocarditis
antimicrobial prophylaxis.
Aboubakr Elnashar
75. •Patients with a history of anaphylactic
reactions to penicillin should not receive
cephalosporins.
•Pretest screening for bacteriuria or UTI by
urine culture or urinalysis, or both, is
recommended in women undergoing
urodynamic testing. Those with positive
results should be given antibiotic treatment.
Aboubakr Elnashar