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Matulatan F
Antibiotic Observer
GLOBAL PROBLEM
overuse
misuse
Rational
underuse
Resistant Microbes
• Trauma
• Non Trauma
Trauma Wounds
High Risk
* Immunocompromised
* Joint wounds
* Grossly contaminated wounds that cannot be adequately cleaned
* Wounds with significant delay (over golden period)
* Retained foreign body
* Puncture wounds
* Crush injuries
* Bite wounds
* Oral wounds
Wound Class
Clean
non-infective operative wounds in which no inflammation is encountered, and neither the respiratory,
alimentary, genito-urinary tract nor the oropharyngeal cavity is entered
In addition these cases are elective, have primary closure, and wounds are drained with closed drainage systems
when required
Clean-Contaminated
operative wounds in which the respiratory, alimentary, genital or urinary tract is entered under controlled
conditions and without unusual contamination.
Specifically, operations involving the biliary tract, appendix, vagina and oropharynx are included in this category,
provided no evidence of infection or a major break in sterile technique is encountered
Wound Class
Contaminated
fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from the
gastro-intestinal tract, and incisions in which acute, non-purulent inflammation is encountered
Dirty
old traumatic wounds with retained devitalised (dead) tissue and those that involve existing clinical
infection or perforated viscera (internal organs or gut).
This definition suggests that organisms causing postoperative infection were present in the operative field
before the surgery
Clean Clean-Contaminated
Contaminated Dirty
▪ First generation cephalosporin(cefazolin)
▪ Give antibiotic 30-60 minutes before incision
▪ Only use aminoglygosides if necessary
Antibiotic
▪ All prophylactic antibiotics should be
Prophylaxis discontinued within 24hours
Prophylactic antibiotic use in penetrating
abdominal trauma
Prior to routine use of antibiotics for surgical site infections
• Mortality rate 65% to 70%
EAST first published guidelines in 1998 for the use prophylactic antibiotics
• Decreased infection rates
There is evidence to support a Level I recommendation that prophylactic antibiotics should only be administered for 24
hours in the presence of a hollow viscus injury
In addition, there are no data to support continuing prophylactic antibiotics longer than 24 hours in damage control
laparotomy
ANTIBIOTIC PROPHYLAXIS IN COLORECTAL
SURGERY
• ERTAPENEM 1 G, CEFUROXIME 1.5 G AND CEFAZOLIN 2 G WERE THE ONLY ANTIBIOTIC REGIMENS THAT CONSISTENTLY
YIELDED TARGET FT > MIC OF 100% FOR THE ENTIRE 4-H POST-DOSE INTERVAL AND AGAINST ALL TARGETED
ORGANISMS MORE THAN 90% OF THE TIME
• ERTAPENEM DISPLAYED EXCELLENT PD PROPERTIES AND GOOD CLINICAL EFFICACY BUT CONCERNS REGARDING THE
ROUTINE USE OF CARBAPENEMS FOR SURGICAL PROPHYLAXIS AND THE POTENTIAL FOR INCREASED CARBAPENEM
RESISTANCE HAVE ALREADY BEEN CLEARLY EXPRESSED
• Not support the routine use of postoperative antibiotic prophylaxis in patients with maxillofacial fractures
• Avoiding the unnecessary use of antibiotic therapy in the postoperative period could have important implications
for healthcare costs and patient outcomes
The efficacy of postoperative antibiotic regimens in the open treatment of
mandibular fractures: a prospective randomized trial Objective
*To determine the necessity and/or effectiveness of postoperative antibiotics in the treatment of mandible
* Prospective and randomized at a single institution
* Underwent open reduction and internal fixation
Intervention
* Both groups received pre-op and intra-op antibiotics on the day of surgery
* Post-op
» No antibiotics
» Penicillin G or clindamycin (Penicillin G allergic) for 5-7 days
Results
» 81 patients received ABX vs. 100 with no ABX post-op
» 22 overall infections
» 8 infection in the treatment group
» 14 infections in the group without ABX post-op
» No statistical difference between the groups (p=0.399)
Type I Open fracture with skin wound < 1 cm in length and clean
Type II Open fracture with laceration > 1 cm in length without extensive soft tissue damage, flaps
or avulsions
Type III Open segmental fracture with > 10 cm wound, extensive soft tissue damage or traumatic
amputation (special categories include: gunshot fractures and farm injuries)
IIIA Adequate soft tissue coverage
IIIB Significant soft tissue loss with exposed bone that requires soft tissue transfer to achieve
coverage
IIIC Associated vascular injury that requires repair for limb preservation
Gustilo RB. J Trauma. 1984;24(8):742-746
The Role of Antibiotic Prophylaxis for
Prevention of Infection in Patients With
Simple Hand Lacerations
Trauma
The median age of patients was 2 years 2 months. The five most common conditions seen in the emergency department were wheezy
bronchitis, upper respiratory tract infections, tonsillitis, pneumonia and diarrhoea
A total of 311 children (62%) received antibiotics
The antibiotics prescribed were predominantly cephalosporins and penicillins
> one antibiotic was used in 51 patients, totally, 75% of the antibiotics prescribed were cephalosporins
More than three-quarters of the young children with wheezy bronchitis received antibiotics
Antibiotic use for children with an upper respiratory tract infections or tonsillitis was greater than the 20% maximum recommended by
the European Surveillance of Antimicrobial Consumption
Conclusions: The majority of children attending the emergency department received antibiotics.
For many of the conditions, the use of antibiotics was inappropriate
Journal of Antimicrobial Chemotherapy, Volume 74, Issue 2, February 2019, Pages 515–20
Sepsis-causing bacteria overcome this mechanism of human innate immunity by versatile respiration, production of antioxidant
enzymes, hemolysins, exo- and endotoxins, exopolymers and other factors that suppress host defense and provide bacterial
survival
Entering the bloodstream in different forms (planktonic, encapsulated, L-form, biofilm fragments), they cause different types of
bacteremia (fulminant, acute, subacute, chronic, etc.)
Sepsis treatment includes antibacterial therapy, support of host vital functions and restore of homeostasis
The latter should inhibit the production of bacterial antioxidant enzymes and hemolysins, neutralize bacterial toxins, modulate
bacterial respiration, increase host tolerance to bacterial products, facilitate host bactericidal mechanism and disperse bacterial
capsule and biofilm
Selection and Dosing ?