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SURGICAL SITE INFECTIONS

CAUSATIVE ORGANISMS

CLEAN PROCEDURES (operations not entering GI tract, axilla, perineum, or female genital tract)
  • ​Staph aureus
  • Streptococci
INTESTINAL TRACT, FEMALE GENITAL TRACT
  • Mixed gram positive, gram negative, and anaerobes
AXILLA
  • Gram negative
PERINEUM
  • Gram negative and anaerobes

RECOMMENDED TREATMENT
  1. Suture removal and incision and drainage recommended
  2. For surgical site infections following clean procedures on trunk, head and neck, or extremities with systemic signs of infection- short course of therapy is recommended for antibiotics (for 5 days).
  3. For surgical site infections with significant systemic response (erythema and induration ≥ 5 cm from wound edge, temperature >38.5⁰C, heart rate >110 bpm, or WBC >12000) systemic antibiotic are recommended:
​
ANTIBIOTIC OPTIONS

IF NO MRSA RISK FACTORS (SEE BELOW) AND SURGERY WAS NOT PERFORMED ON INTESTINAL TRACT, GENITAL TRACT, NEAR AXILLA, OR NEAR PERINEUM, USE ONE OF THE FOLLOWING:
  • Cefazolin 1 gm IV q8h
  • Nafcillin 2 g IV q6h
  • If pencillin/cephalosporin allergy, give clindamycin 600 mg IV q8hr

If MRSA risk factors present (MRSA nasal colonization, prior history of MRSA infection, recent hospitalization, recent antibiotic use), use one of the following as monotherapy instead of the choices above:
  1. Vancomycin
  2. Daptomycin 4 mg/kg IV q24h (need ID consult)
  3. Linezolid 600 mg q12h (need ID consult)​

​IF SURGERY IS ON INTESTINAL TRACT OR GENITAL TRACT:
  • Cefepime 1 gm IV q8h +metronidazole 500 mg IV q8h +/- vancomycin (depending on MRSA risk factors above)
  • Piperacillin/tazobactam 3.375 gm IV q8h +/- vancomycin (depending on MRSA risk factors above)
  • Ampicillin/sulbactam 3 gm IV q6h +/- vancomycin (depending on MRSA risk factors above)
  • Levofloxacin 750 mg IV q24h + metronidazole 500 mg IV q8h +/- vancomycin (depending on MRSA risk factors above)
​
IF SURGERY ON AXILLA OR PERINEUM:
  • Cefepime 1 gm IV q8h + metronidazole 500 mg IV q8h +/- vancomycin (depending on MRSA risk factors above)
  • Levofloxacin 750 mg IV q24h + metronidazole 500 mg IV q8h +/- vancomycin (depending on MRSA risk factors above)
  • COVID
    • INPATIENT >
      • CONSIDERATIONS & LABS
      • REMDESIVIR
      • OLUMIANT
      • ACTEMRA
      • STEROIDS
      • VTE
    • OUTPATIENT
  • Education
    • Bugs & Tips
    • Agents & Spectra
  • Guidelines
    • By Infection Type
    • Surgical Prophylaxis >
      • By Procedure
      • Dosing Guide
  • Formulary
  • Antibiogram
    • 2022 Inpatient
    • 2022 Outpatient
    • 2021 Inpatient
    • 2021 Outpatient
    • 2020 Inpatient
    • 2019 Inpatient
    • 2019 Outpatient
    • 2018 Inpatient
    • 2018 Outpatient
    • 2017 Inpatient
    • 2017 Outpatient
    • 2016 Inpatient
    • 2016 Outpatient
    • 2015 Inpatient
    • 2015 Outpatient
    • 2014 Inpatient
  • About
    • ASP Program
    • Stats & Data >
      • Recommendations
      • Pharmacy Data
      • MDR ORGANISMS
      • DDD/DOT
    • Contact