Treatment
Table 2. Specific Sites of an Organ/Space SSIa
Arterial or venous infection
Mediastinitis
Breast abscess or mastitis
Meningitis or ventriculitis
Disc space
Myocarditis or pericarditis
Ear, mastoid
Oral cavity (mouth, tongue, or gums)
Endocarditis
Osteomyelitis
Endometritis
Other infections of the male or female
reproductive tract
Eye, other than conjunctivitis
Other infections of the respiratory tract
GI tract
Other infections of the urinary tract
Hepatitis
Sinusitis
Intraabdominal, not specified elsewhere
Spinal abscess without meningitis
Intracranial, brain abscess or dura
Upper respiratory tract
Joint or bursa
Vaginal cuff
a
Modified from the published guidelines to include recently updated definitions from the NHSN
Centers for Disease Control and Prevention. Procedure-Associated Module: Surgical Site Infection
Event. National Healthcare Safety Network Patient Safety Component. 2013 Jan. http://www.cdc.
gov/nhsn/psc_pa.html (accessed 2013 Feb 14).
ÎÎAntimicrobial prophylaxis may be beneficial in surgical procedures
associated with:
• A high rate of infection (ie, clean-contaminated or contaminated procedures)
• Prosthetic implants
• Severe consequences, even if infection is unlikely
ÎÎCertain clean procedures may also warrant prophylaxis.
Note: While prophylactic antimicrobials are not indicated for some clean surgical
procedures, available data suggest that the relative risk reduction of SSI from the use of
antimicrobial prophylaxis is the same in clean and in higher-risk procedures. The decision
to use or not use prophylaxis depends on the cost of treating and the morbidity associated
with infection compared with the cost and morbidity associated with using prophylaxis.
ÎÎAntimicrobial prophylaxis is justified for most clean-contaminated
procedures where the predominant organisms include Gram-negative
rods and enterococci.
ÎÎThe use of antimicrobial agents for dirty procedures or established
infections is classified as treatment of presumed infection, not prophylaxis.
ÎÎThe selection of an appropriate antimicrobial agent for a specific
patient should take into account the characteristics of the ideal agent,
comparative efficacy of the antimicrobial agent for the procedure,
safety profile, and patient medication allergies.
• Choose antimicrobial agents with the narrowest spectrum of activity required for
efficacy in preventing infection.
• For patients known to be colonized with methicillin-resistant Staphylococcus
aureus (MRSA), it is reasonable to add a single preoperative dose of vancomycin to
the recommended agent(s).
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