prophylaxis for perioperative infection

^[1]^[2]^[3]^[4]

Complications

incidence of kidney injury & C difficile infection increases with increasing duration of antibiotic prophylaxis^[3]
- use of vancomycin increases risk of kidney injury for all types of surgery
- use of clindamycin or fluoroquinolones increases risk of C difficile infection^[3]

1st generation cephalosporin
- administer 2 hours preoperatively
- cefazolin monotherapy is standard of care
  - addition of vanocomycin for total knee arthroplasty or hip arthroplasty of no benefit^[4]
do not use broad-spectrum antibiotics for uncomplicated clean & clean-contaminated procedures^[2]
perioperative prophylaxis should not continue after the incision is closed^[2]
ceph

↑ Medical Knowledge Self Assessment Program (MKSAP) 11,19 American College of Physicians, Philadelphia 1998. 2022
↑ ^2.0 ^2.1 ^2.2 American Academy of Pediatrics - Committee on Infectious Diseases and the Pediatric Infectious Diseases Society. Choosing Wisely. November 12, 2018 http://www.choosingwisely.org/societies/american-academy-of-pediatrics-committee-on-infectious-diseases-and-the-pediatric-infectious-diseases-society/
↑ ^3.0 ^3.1 ^3.2 Branch-Elliman W, O'Brien W, Strymish J et al. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019 Jul; 154:590. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31017647 https://jamanetwork.com/journals/jamasurgery/fullarticle/2731307
Hawn MT, Knowlton LM. Balancing the risks and benefits of surgical prophylaxis: Timing and duration do matter. JAMA Surg 2019 Jul; 154:598. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31017641 https://jamanetwork.com/journals/jamasurgery/fullarticle/2731303
↑ ^4.0 ^4.1 Peel TN et al. Trial of vancomycin and cefazolin as surgical prophylaxis in arthroplasty. N Engl J Med 2023 Oct 19; 389:1488 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37851875 https://www.nejm.org/doi/10.1056/NEJMoa2301401