Patients with Prosthetic Implants
����For patients with existing prosthetic implants who undergo an invasive
procedure, there is no evidence that antimicrobial prophylaxis
prevents infections of the implant. However, updated guidelines
from the American Heart Association suggest that prophylaxis may
be justified in a limited subset of patients for the prevention of
endocarditis.
Colonization
����S. aureus (MSSA or MRSA) colonizes a significant portion of surgical
patients and is a leading cause of all SSIs in the United States.
S. aureus colonization is associated with a significantly increased risk
of SSI.
����Endogenous S. aureus carriage in surgical patients requires a
specialized approach for eradication of these pathogens.
Notes: Preoperative surveillance cultures can be used to identify colonized patients in
the preoperative period.
Anterior nasal swab cultures are most commonly used, but evidence suggests that
additional site screening (pharynx, groin, wounds, rectal) can increase detection.
����The use of decolonization therapy (eg, mupirocin) may be employed
as an adjunctive measure to prevent S. aureus SSI with surveillance of
susceptibility to mupirocin of S. aureus isolated from SSIs.
Notes: While universal use of mupirocin is discouraged, data demonstrate a 45%
reduction in S. aureus SSI with the use of preoperative mupirocin among patients
known to be colonized with S. aureus undergoing cardiac procedures.
Mupirocin should be given intranasally to all patients with documented
colonization with S. aureus undergoing orthopedic spinal procedures with or without
instrumentation.
����The safety and efficacy of topical antibiotics have not been clearly
established, and therefore routine use of this route cannot be
recommended.
Existing Antibiotic Treatment
����If the agent(s) used therapeutically is (are) appropriate for surgical
prophylaxis, administering an extra dose within 60 minutes prior
to incision is sufficient. Otherwise, use the antibiotic prophylaxis
recommended for the planned procedure.
����Because the predominant organisms in SSIs after clean procedures
are Gram positive, the use of vancomycin may be appropriate for a
patient with a life-threatening allergy to �� -lactam antibiotics.
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