The Use Of Antibiotics In Surgical Patients
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The Use of Antibiotics in Surgical Patients ศา สตร าจาร ย์น ายแพท ย์ วิ ษณุ ธร รมล ิขิต กุล ภาคว ิชา อา ยุร ศา สตร ์ คณ ะแพท ยศ าสต ร์ศิ ริ รา ชพ ยา บ
Antimicrobial Agents & Other Drugs Mechanisms of Actions Consequences of Inappropriate Use Morbidity & Mortality Financial Loss Induction of Resistance
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Organisms Causing Infections in Surgery
Bacteria Gram Positive Cocci : Staphylococcus aureus & epidermidis Streptococcus group A Enterococcus spp. Anaerobic Streptococci Gram Positive Bacilli : Clostridium spp.
Organisms Causing Infections in Surgery
Bacteria Gram Negative Bacilli : Enterobacteriaceae (E.coli, Klebsiella, Enterobacter, Proteus spp.) Pseudomonas aeruginosa Non-fermenters : Acinetobacter spp. Bacteriodes spp.
Organisms Causing Infections in Surgery
Fungus Candida spp. Aspergillus spp.
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Beta-Lactams Penicillins Cephalosporins Beta-Lactam + Beta-Lactamase Inhib. Monobactam Carbepenems
Penicillins Natural Penicillins : Penicillin G & Penicillin V Strep. gr. A, S. pneumoniae, Enterococcus, Gram positive Rods & anaerobic streptococci Penicillinase-Resistant Penicillins : Cloxacillin, Dicloxacillin, Flucloxacillin Staphylococcus spp. ( non-MRS )
Penicillins Aminopenicillins : Ampicillin & Amoxicillin same as natural penicillins & some Gram negative bacilli Anti-Pseudomonas Penicillins : Piperacillin Gram negative bacilli including Pseudomonas aeruginosa
Cephalosporins Generation 1 : Cefazolin, Cephalexin Generation 2 : Cefuroxime, Cefamandole, Cefoxitin, Cefprozil Generation 3A : Cefotaxime, Ceftriaxone, Cefixime, Cefdinir, Ceftributen, Cefpodoxime Generation 3B : Ceftazidime, Cefoperazone Generation 4 : Cefpirome, Cefepime
Antibacterial Spectrum of Cephalosporins Ceph.1 Ceph.2 Ceph.3A Ceph.3B Ceph.4 Strep., Staph. 4+ 2+/3+ Pen.R.S.pneumo. 0 0 MRSA 0 0 Enterococcus spp. 0 0 Enterobacteriaceae Community 2+/3+ 3+/4+ Hospital 0 /1+ 1+/2+ P.aeruginosa 0 0 B.fragilis 0 0/3+
3+ 3+ 0 0 4+ 3+/4+ 0 0
0/1+ 0 0 0 4+ 2+/3+ 4+ 0
3+ 3+/4+ 0 0 4+ 4+ 4+ 0
Beta-Lactam + Beta-Lactamase Inhibitors Amoxicillin + Clavulanate, Ampicillin + Sulbactam, Cefoperazone + Sulbactam, Piperacillin + Tazobactam Streptococci Staphylococci ( MSSA ) Gram negative Bacilli & Anaerobes with Beta-Lactamase producing
Monobactam Aztreonam Aerobic Gram negative Bacilli including Pseudomonas aeruginosa
Carbapenems Imipenem & Meropenem Streptococci, Enterococci Staphylococci ( MSSA ) Gram negative Bacilli including P. aeruginosa Anaerobes including B. fragilis Non-fermenters : Acinetobacter spp.
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Aminoglycosides Neomycin Streptomycin Kanamycin Gentamicin Netilmicin Amikacin
Anti-Bacterial Spectrum of Aminoglycosides Bacteria
Gentamicin Netilmicin/Amikacin
Enterobacteriaceae Community 2+/4+ Hospital 0 /2+ P.aeruginosa 1+/2+ Gram positives 0 /1+ Anaerobes 0
4+ 3+/4+ 3+ 0 / 1+ 0
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Quinolones First Generation : Norfloxacin, Ofloxacin, Ciprofloxacin, Fleroxacin Second Generation : Sparfloxacin, Gatifloxacin, Trovafloxacin, Moxifloxacin
Anti-Bacterial Spectrum of Quinolones Gram Neg.Rods Gram Pos.Cocci Anaerob.
Norfloxacin Ofloxacin Ciprofloxacin Sparfloxacin Gatifloxacin Trovafloxacin
(strep., MSSA) 2+ 0 /1+ 0 3+/4+ 0 /1+ 0 3+/4+ 0 /1+ 0 3+/4+ 3+ 0 /2+ 3+/4+ 3+ 2+ 3+/4+ 3+ 3+
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Lincosamides Lincomycin & Clindamycin Gram Positive Bacteria : Streptococci, Staphylococci (MSSA), Gram positive rods Anaerobes including Bacteroides fragilis
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Glycopeptides Vancomycin & Teicoplanin Resistant Gram Positive Bacteria S. pneumoniae, Enterococcus spp., Staphyloccoi including MRSA & MRSE
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Anti-fungals Fluconazole Candida albicans Amphotericin B Candida spp. & Aspergillus spp.
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Antibiotic Prophylaxis in Surgery 1 Aseptic Technique Types of Operation/Procedure/Wound Clean Clean-Contaminated Contaminated Dirty
Antibiotic Prophylaxis in Surgery Types of Operation/Procedure/Wound Clean Clean-Contaminated Low Risk No Antibiotic
Contaminated Dirty
High Risk Serious if Infected Antibiotic Antibiotic Therapy
Antibiotic Prophylaxis in Surgery 2 Organisms of Concern : Flora Staphylococci & Streptococci Gram Negative Rods Anaerobes
Antibiotic Prophylaxis in Surgery 3 Types of Antibiotics Non-GI Tract : Cefazolin or Cloxacillin +/- Gentamicin GI Tract : Metronidazole (or Pen G. or Clindamycin) + Gentamicin Cefoxitin or BL / BI
Antibiotic Prophylaxis in Colorectal Surgery Antimicrobial prophylaxis in colorectal surgery : A systematic review of randomized controlled trials. British J Surgery 1998; 85: 1232-41 Antibiotic prophylaxis is effective for prevention of surgical wound infection after colorectal surgery. Certain regimens appear to be inadequate eg. Metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin + erythromycin Efficacy of anti-Gram negative + anti-anaerobes regimens are not significantly different.
Antibiotic Prophylaxis in Surgery 4 Optimum Timing Induction of Anesthesia Optimum Duration Single dose, < 48 hours Adverse Effects & Costs & Convenience
Optimum Duration of Antibiotic Prophylaxis Single versus multiple-dose antimicrobial prophylaxis for major surgery ( Aust NZ J Surg 1999; 69: 388-96 ) Systematic review to determine overall efficacy of single versus multiple-dose anti-microbial prophylaxis for major surgery across surgical disciplines Postoperative surgical site infections are not different between single vs multiple dose, types of antimicrobials (beta-lactam vs others), type of surgery, length of multiple dose (24 h.vs>24 h.)
Antibiotic Prophylaxis in Surgery 4 Optimum Timing Induction of Anesthesia Optimum Duration Single dose, < 48 hours Adverse Effects & Costs & Convenience
Local Antibiotic Prophylaxis in Surgery Infect Cont & Hosp Epidemiol 1996; 17: 539 Oral decontamination of the bowel Irrigation of the surgical wound Topical antibiotics in the surgical wound Liposome-delivered antibiotics Mouthwash in ENT surgery Intravenous limb injection below a tourniquet Antibiotic-bonded vascular graft Antibiotic-impregnated orthopedic cement Antibiotic-impregnated methyl-acrylate beads
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Common Intra-Abdominal Infections Biliary Tract Infections Appendicitis Peritonitis ( Primary & Secondary ) Intra-Abdominal Abscess
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Direct contamination Enterobacteriaceae ( E. coli ) Anaerobes ( Gram + & B.fragilis ) Enterococcus spp.
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Bacteremia Enterobacteriaceae ( E. coli ) Non GI Tract Flora - Any S.pneumoniae, S.aureus, B.pseudomallei, Mycobacterium spp.
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Direct contamination Enterobacteriaceae ( E. coli ) Anaerobes ( Gram + & B.fragilis ) Enterococcus spp.
Antibiotic Susceptibility Penicillin Metronidazole Clindamycin Aminoglycoside Monobactam Quinolone Cephalosporins BL + BI Carbapenems
GNR
An.G +
An.G -
Enteroc.
0 0 0 3+/4+ 3+/4+ 3+/4+ 3+/4+ 1+/3+ 3+/4+
4+ 0/1+ 4+ 0 0 0 2+/3+ 4+ 4+
0/1+ 4+ 3+/4+ 0 0 0 0 3+ 3+
3+ 0 0 0 0 0 0 3+ 2+/3+
Empiric Antibiotic Therapy Intra-Abdominal Infections, GI Flora Related
Conventional Regimen Metronidazole (+/- Pen G) or Clindamycin + Cephalosporins or Aminoglycosides
Cephalosporins Generation 3 Cefotaxime Ceftriaxone Ceftazidime Generation 4 Cefepime Cefpirome
Enterobac. P.aeruginosa GPC 3+ 3+ 2+/3+
0 0 3+
3+ 3+ 0/1+
3+/4+ 3+/4+
3+ 3+
3+ 3+
Aminoglycosides Enterobacteriaceae P.aeruginosa Gentamicin
1+/3+
1+/2+
Amikacin
3+/4+
3+/4+
Netilmicin
3+/4+
3+/4+
Empiric Antibiotic Therapy Intra-Abdominal Infections, GI Flora Related Alternative Regimens Bl + BI : Amoxicillin/Clavulanate Ampicillin/Sulbactam Piperacillin/Tazobactam Carbapenems : Imipenem, Meropenem
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Post Operative Infections ( Hospital-Acquired/Nosocomial Infections )
Pneumonia Urinary Tract Infections Wound Infections Sepsis
Hospital Acquired Pneumonia Organisms P. aeruginosa
% 27
Klebsiella spp., E.coli, Enterobacter spp. 24 Acinetobacter spp.
20
S. aureus
11
Serratia spp.
3
Hospital Acquired Urinary Tract Infection Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
65
P. aeruginosa
15
Acinetobacter spp.
5
Enterococcus spp.
4
Hospital Acquired Wound Infection Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
29
P. aeruginosa
23
S. aureus
17
Acinetobacter spp.
11
Streptococcus spp.
2
Hospital Acquired Bacteremia Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
35
S. aureus
18
P. aeruginosa
10
Acinetobacter spp.
7
Post Operative Infections
Pneumonia UTI Wounds Sepsis
Causative Agents GNRs GPC Candida 3+/4+ 1+/2+ 1+ 3+/4+ 1+ 1+/2+ 2+/3+ 2+/3+ 0/1+ 3+/4+ 2+/3+ 1+
Causative Bacteria Gram Negative Bacteria Drug Resistant Enterobacteriaceae Pseudomonas aeruginosa Non-Fermenters eg. Acinetobacter spp. Gram Positive Bacteria S. aureus ( MRSA ), S. pyogenes Enterococcus spp. ( VRE ) Candida spp.
Anti Gram Negative Bacteria Enterobac. Ps. NF Cefotaxime, Ceftriaxone 2+/3+ 0 1+/2+ Ceftazidime 2+ 3+ 1+/2+ Cefepime, Cefpirome 3+/4+ 3+ 1+/2+ Beta-Lactam/BLI 2+/4+ 0/3+ 0/3+ Amikacin 2+/3+ 3+ 1+/2+ Ciprofloxacin 1+/3+ 2+ 1+/2+ Imipenem, Meropenem 3+/4+ 3+/4+ 3+
Anti Gram Positive Bacteria S.pyogenes : Penicillin G S.aureus (MSSA) : Cloxacillin S.aureus (MRSA) : Glycopeptides (Vancomycin/Teicoplanin) Enterococcus spp.: PenG/Ampicillin/Vanco. + Gentamicin VRE : Linezolid
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Antimicrobial Agents & Other Drugs Mechanisms of Actions Consequences of Inappropriate Use Morbidity & Mortality Financial Loss Induction of Resistance
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Organisms Causing Infections in Surgery
Bacteria Gram Positive Cocci : Staphylococcus aureus & epidermidis Streptococcus group A Enterococcus spp. Anaerobic Streptococci Gram Positive Bacilli : Clostridium spp.
Organisms Causing Infections in Surgery
Bacteria Gram Negative Bacilli : Enterobacteriaceae (E.coli, Klebsiella, Enterobacter, Proteus spp.) Pseudomonas aeruginosa Non-fermenters : Acinetobacter spp. Bacteriodes spp.
Organisms Causing Infections in Surgery
Fungus Candida spp. Aspergillus spp.
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Beta-Lactams Penicillins Cephalosporins Beta-Lactam + Beta-Lactamase Inhib. Monobactam Carbepenems
Penicillins Natural Penicillins : Penicillin G & Penicillin V Strep. gr. A, S. pneumoniae, Enterococcus, Gram positive Rods & anaerobic streptococci Penicillinase-Resistant Penicillins : Cloxacillin, Dicloxacillin, Flucloxacillin Staphylococcus spp. ( non-MRS )
Penicillins Aminopenicillins : Ampicillin & Amoxicillin same as natural penicillins & some Gram negative bacilli Anti-Pseudomonas Penicillins : Piperacillin Gram negative bacilli including Pseudomonas aeruginosa
Cephalosporins Generation 1 : Cefazolin, Cephalexin Generation 2 : Cefuroxime, Cefamandole, Cefoxitin, Cefprozil Generation 3A : Cefotaxime, Ceftriaxone, Cefixime, Cefdinir, Ceftributen, Cefpodoxime Generation 3B : Ceftazidime, Cefoperazone Generation 4 : Cefpirome, Cefepime
Antibacterial Spectrum of Cephalosporins Ceph.1 Ceph.2 Ceph.3A Ceph.3B Ceph.4 Strep., Staph. 4+ 2+/3+ Pen.R.S.pneumo. 0 0 MRSA 0 0 Enterococcus spp. 0 0 Enterobacteriaceae Community 2+/3+ 3+/4+ Hospital 0 /1+ 1+/2+ P.aeruginosa 0 0 B.fragilis 0 0/3+
3+ 3+ 0 0 4+ 3+/4+ 0 0
0/1+ 0 0 0 4+ 2+/3+ 4+ 0
3+ 3+/4+ 0 0 4+ 4+ 4+ 0
Beta-Lactam + Beta-Lactamase Inhibitors Amoxicillin + Clavulanate, Ampicillin + Sulbactam, Cefoperazone + Sulbactam, Piperacillin + Tazobactam Streptococci Staphylococci ( MSSA ) Gram negative Bacilli & Anaerobes with Beta-Lactamase producing
Monobactam Aztreonam Aerobic Gram negative Bacilli including Pseudomonas aeruginosa
Carbapenems Imipenem & Meropenem Streptococci, Enterococci Staphylococci ( MSSA ) Gram negative Bacilli including P. aeruginosa Anaerobes including B. fragilis Non-fermenters : Acinetobacter spp.
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Aminoglycosides Neomycin Streptomycin Kanamycin Gentamicin Netilmicin Amikacin
Anti-Bacterial Spectrum of Aminoglycosides Bacteria
Gentamicin Netilmicin/Amikacin
Enterobacteriaceae Community 2+/4+ Hospital 0 /2+ P.aeruginosa 1+/2+ Gram positives 0 /1+ Anaerobes 0
4+ 3+/4+ 3+ 0 / 1+ 0
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Quinolones First Generation : Norfloxacin, Ofloxacin, Ciprofloxacin, Fleroxacin Second Generation : Sparfloxacin, Gatifloxacin, Trovafloxacin, Moxifloxacin
Anti-Bacterial Spectrum of Quinolones Gram Neg.Rods Gram Pos.Cocci Anaerob.
Norfloxacin Ofloxacin Ciprofloxacin Sparfloxacin Gatifloxacin Trovafloxacin
(strep., MSSA) 2+ 0 /1+ 0 3+/4+ 0 /1+ 0 3+/4+ 0 /1+ 0 3+/4+ 3+ 0 /2+ 3+/4+ 3+ 2+ 3+/4+ 3+ 3+
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Lincosamides Lincomycin & Clindamycin Gram Positive Bacteria : Streptococci, Staphylococci (MSSA), Gram positive rods Anaerobes including Bacteroides fragilis
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Glycopeptides Vancomycin & Teicoplanin Resistant Gram Positive Bacteria S. pneumoniae, Enterococcus spp., Staphyloccoi including MRSA & MRSE
Commonly Used Antibiotics in Surgery Beta-Lactams Aminoglycosides Quinolones Lincosamides Metronidazole Glycopeptides Anti-fungals
Anti-fungals Fluconazole Candida albicans Amphotericin B Candida spp. & Aspergillus spp.
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Antibiotic Prophylaxis in Surgery 1 Aseptic Technique Types of Operation/Procedure/Wound Clean Clean-Contaminated Contaminated Dirty
Antibiotic Prophylaxis in Surgery Types of Operation/Procedure/Wound Clean Clean-Contaminated Low Risk No Antibiotic
Contaminated Dirty
High Risk Serious if Infected Antibiotic Antibiotic Therapy
Antibiotic Prophylaxis in Surgery 2 Organisms of Concern : Flora Staphylococci & Streptococci Gram Negative Rods Anaerobes
Antibiotic Prophylaxis in Surgery 3 Types of Antibiotics Non-GI Tract : Cefazolin or Cloxacillin +/- Gentamicin GI Tract : Metronidazole (or Pen G. or Clindamycin) + Gentamicin Cefoxitin or BL / BI
Antibiotic Prophylaxis in Colorectal Surgery Antimicrobial prophylaxis in colorectal surgery : A systematic review of randomized controlled trials. British J Surgery 1998; 85: 1232-41 Antibiotic prophylaxis is effective for prevention of surgical wound infection after colorectal surgery. Certain regimens appear to be inadequate eg. Metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin + erythromycin Efficacy of anti-Gram negative + anti-anaerobes regimens are not significantly different.
Antibiotic Prophylaxis in Surgery 4 Optimum Timing Induction of Anesthesia Optimum Duration Single dose, < 48 hours Adverse Effects & Costs & Convenience
Optimum Duration of Antibiotic Prophylaxis Single versus multiple-dose antimicrobial prophylaxis for major surgery ( Aust NZ J Surg 1999; 69: 388-96 ) Systematic review to determine overall efficacy of single versus multiple-dose anti-microbial prophylaxis for major surgery across surgical disciplines Postoperative surgical site infections are not different between single vs multiple dose, types of antimicrobials (beta-lactam vs others), type of surgery, length of multiple dose (24 h.vs>24 h.)
Antibiotic Prophylaxis in Surgery 4 Optimum Timing Induction of Anesthesia Optimum Duration Single dose, < 48 hours Adverse Effects & Costs & Convenience
Local Antibiotic Prophylaxis in Surgery Infect Cont & Hosp Epidemiol 1996; 17: 539 Oral decontamination of the bowel Irrigation of the surgical wound Topical antibiotics in the surgical wound Liposome-delivered antibiotics Mouthwash in ENT surgery Intravenous limb injection below a tourniquet Antibiotic-bonded vascular graft Antibiotic-impregnated orthopedic cement Antibiotic-impregnated methyl-acrylate beads
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Common Intra-Abdominal Infections Biliary Tract Infections Appendicitis Peritonitis ( Primary & Secondary ) Intra-Abdominal Abscess
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Direct contamination Enterobacteriaceae ( E. coli ) Anaerobes ( Gram + & B.fragilis ) Enterococcus spp.
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Bacteremia Enterobacteriaceae ( E. coli ) Non GI Tract Flora - Any S.pneumoniae, S.aureus, B.pseudomallei, Mycobacterium spp.
Intra-Abdominal Infections Causative Organisms GI Tract Flora & Direct contamination Enterobacteriaceae ( E. coli ) Anaerobes ( Gram + & B.fragilis ) Enterococcus spp.
Antibiotic Susceptibility Penicillin Metronidazole Clindamycin Aminoglycoside Monobactam Quinolone Cephalosporins BL + BI Carbapenems
GNR
An.G +
An.G -
Enteroc.
0 0 0 3+/4+ 3+/4+ 3+/4+ 3+/4+ 1+/3+ 3+/4+
4+ 0/1+ 4+ 0 0 0 2+/3+ 4+ 4+
0/1+ 4+ 3+/4+ 0 0 0 0 3+ 3+
3+ 0 0 0 0 0 0 3+ 2+/3+
Empiric Antibiotic Therapy Intra-Abdominal Infections, GI Flora Related
Conventional Regimen Metronidazole (+/- Pen G) or Clindamycin + Cephalosporins or Aminoglycosides
Cephalosporins Generation 3 Cefotaxime Ceftriaxone Ceftazidime Generation 4 Cefepime Cefpirome
Enterobac. P.aeruginosa GPC 3+ 3+ 2+/3+
0 0 3+
3+ 3+ 0/1+
3+/4+ 3+/4+
3+ 3+
3+ 3+
Aminoglycosides Enterobacteriaceae P.aeruginosa Gentamicin
1+/3+
1+/2+
Amikacin
3+/4+
3+/4+
Netilmicin
3+/4+
3+/4+
Empiric Antibiotic Therapy Intra-Abdominal Infections, GI Flora Related Alternative Regimens Bl + BI : Amoxicillin/Clavulanate Ampicillin/Sulbactam Piperacillin/Tazobactam Carbapenems : Imipenem, Meropenem
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
Post Operative Infections ( Hospital-Acquired/Nosocomial Infections )
Pneumonia Urinary Tract Infections Wound Infections Sepsis
Hospital Acquired Pneumonia Organisms P. aeruginosa
% 27
Klebsiella spp., E.coli, Enterobacter spp. 24 Acinetobacter spp.
20
S. aureus
11
Serratia spp.
3
Hospital Acquired Urinary Tract Infection Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
65
P. aeruginosa
15
Acinetobacter spp.
5
Enterococcus spp.
4
Hospital Acquired Wound Infection Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
29
P. aeruginosa
23
S. aureus
17
Acinetobacter spp.
11
Streptococcus spp.
2
Hospital Acquired Bacteremia Organisms
%
E.coli, Klebsiella spp., Enterobacter spp.
35
S. aureus
18
P. aeruginosa
10
Acinetobacter spp.
7
Post Operative Infections
Pneumonia UTI Wounds Sepsis
Causative Agents GNRs GPC Candida 3+/4+ 1+/2+ 1+ 3+/4+ 1+ 1+/2+ 2+/3+ 2+/3+ 0/1+ 3+/4+ 2+/3+ 1+
Causative Bacteria Gram Negative Bacteria Drug Resistant Enterobacteriaceae Pseudomonas aeruginosa Non-Fermenters eg. Acinetobacter spp. Gram Positive Bacteria S. aureus ( MRSA ), S. pyogenes Enterococcus spp. ( VRE ) Candida spp.
Anti Gram Negative Bacteria Enterobac. Ps. NF Cefotaxime, Ceftriaxone 2+/3+ 0 1+/2+ Ceftazidime 2+ 3+ 1+/2+ Cefepime, Cefpirome 3+/4+ 3+ 1+/2+ Beta-Lactam/BLI 2+/4+ 0/3+ 0/3+ Amikacin 2+/3+ 3+ 1+/2+ Ciprofloxacin 1+/3+ 2+ 1+/2+ Imipenem, Meropenem 3+/4+ 3+/4+ 3+
Anti Gram Positive Bacteria S.pyogenes : Penicillin G S.aureus (MSSA) : Cloxacillin S.aureus (MRSA) : Glycopeptides (Vancomycin/Teicoplanin) Enterococcus spp.: PenG/Ampicillin/Vanco. + Gentamicin VRE : Linezolid
CONTENTS Commonly Used Antibiotics Prophylactic Antibiotics Antibiotics for Intra-Abdominal Infections Antibiotics for Post-Operative Infections
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