7
Surgical Site Infections
Î Suture removal plus incision and drainage should be performed for
surgical site infections (SR-L).
Î Adjunctive systemic antimicrobial therapy is NOT routinely indicated
but in conjunction with incision and drainage may be beneficial for
surgical site infections associated with a significant systemic response
(See Figure 2) such as erythema and induration extending >5 cm from
the wound edge, temperature >38.5ºC, heart rate >110/min, or WBC
count >12,000/mm
3
(WR-L).
Î A brief course of systemic antimicrobial therapy is indicated in
patients with surgical site infections after clean operations on the
trunk, head and neck, or extremities that also have systemic signs of
infection (SR-L).
Î A first-generation cephalosporin or an anti-staphylococcal penicillin
for MSSA or vancomycin, linezolid, daptomycin, telavancin or
ceftaroline where risk factors for MRSA are high (nasal colonization,
prior MRSA infection, recent hospitalization, recent antibiotics) is
recommended (SR-L).
Î Agents active against Gram-negative bacteria and anaerobes, such as
a cephalosporin or fluoroquinolone in combination with metronidazole,
are recommended for infections after operations on the axilla,
gastrointestinal (GI) tract, perineum or female genital tract (SR-L).
Necrotizing Fasciitis, Including Fournier's Gangrene
Î Prompt surgical consultation is recommended for patients with
aggressive infections associated with signs of systemic toxicity
or suspicion of necrotizing fasciitis or gas gangrene (See Fig. 1/
Nonpurulent/SEVERE) (SR-L).
Î Empiric antibiotic treatment should be broad (eg, vancomycin or
linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus
ceftriaxone and metronidazole), since the etiology can be polymicrobial
(mixed aerobic-anaerobic microbes) or monomicrobial (Group A
streptococcus, community-acquired MRSA [CA-MRSA]) (SR-L).
Î Penicillin plus clindamycin is recommended for treatment of
documented Group A streptococcal necrotizing fasciitis (SR-L).
