CAUSATIVE ORGANISMS
CLEAN PROCEDURES (operations not entering GI tract, axilla, perineum, or female genital tract)
RECOMMENDED TREATMENT
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:
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:
IF SURGERY IS ON INTESTINAL TRACT OR GENITAL TRACT:
IF SURGERY ON AXILLA OR PERINEUM:
CLEAN PROCEDURES (operations not entering GI tract, axilla, perineum, or female genital tract)
- Staph aureus
- Streptococci
- Mixed gram positive, gram negative, and anaerobes
- Gram negative
- Gram negative and anaerobes
RECOMMENDED TREATMENT
- Suture removal and incision and drainage recommended
- 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).
- 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:
- Vancomycin
- Daptomycin 4 mg/kg IV q24h (need ID consult)
- 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)