Episode Notes

The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.

Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and more!

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp

If you’d like more information about the CALIPSO trial, please visit this link: https://www.anzca.edu.au/profiles/ctn-trials/underway/calipso

Bibliography

1. SSI Infection Prevention Review: https://jamanetwork.com/journals/jama/article-abstract/2800424#:~:text=Six%20are%20supported%20by%20randomized,use%20a%20chlorhexidine%20gluconate%2Dalcoho
2. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-surgical-site-infections-in-acutecare-hospitals-2022-update/2F824B9ADD6066B29F89C8A2A127A9D
3. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update: https://journals.lww.com/journalacs/citation/2017/01000/american_college_of_surgeons_and_surgical.8.aspx 
4. 2017 CDC Guidelines: https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725 
5. 2018 WHO Guidelines: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
6. ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery: https://www.ashp.org/surgical-guidelines 
7. Surgeons as Stewards: https://journals.lww.com/journalacs/citation/2020/12000/perioperative_antibiotic_prophylaxis__surgeons_as.23.aspx 
8. Li et al, Arthroplasty 2022: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
9. Dutch Arthroplasty Register Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023957/ 
10. de Jonge Meta-Analysis on duration and incidence of SSI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/abstract 
11. Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance: https://www.ahajournals.org/doi/10.1161/01.cir.101.25.2916?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
12. RCT - Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: https://jamanetwork.com/journals/jama/article-abstract/2810510 
13. NYU Langone Study - Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=91dee3e1445adb80d533f2c210816a3285254e3a 
14. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty: https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
15. What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744972/ 
16. Drug allergy: a 2022 practice parameter update: https://www.jacionline.org/article/S0091-6749(22)01186-1/fulltext 
17. Perioperative use of cefazolin without preliminary skin testing in patients with reported penicillin allergy: https://www.surgjournal.com/article/S0039-6060(18)30307-6/abstract#%20 
18. Timing of Surgical Prophylaxis RCT: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30176-7/abstract 
19. Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815528