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Transcript
Neurosurgical
LIKELY
PATHOGENS
• ANTIMICROBIAL
REGIMEN (Adult)
ANTIMICROBIAL REGIMEN
(Pediatric)
OR REDOSING
COMMENTS
Craniotomy
Staphylococcus aureus,
coagulase-negative
staphylococci
• Cefazolin4 1 g IV pre-op
(2 g if > 80 kg)
• Cefazolin 25mg/kg IV preop (Maximum of 1 g)
• Cefazolin every 4
hours
Organisms listed represent >85%
of post-op infections
Cerebrospinal
fluid
shunt
Staphylococci account
for 75-80% of wound
infections following shunt
procedures; Gram-negative bacteria 1-20%.
• Cefuroxime4,5 1.5 g IV preop
• Cefuroxime 30mg/kg IV
(Maximum of 1.5g) pre-op
• Cefuroxime every 4
hours
----- or
---- Or
• Vancomycin 1 g IV as a
single dose
• Vancomycin 15mg/kg IV
(Maximum of 1 g) pre-op
• Vancomycin none;
every 6 hours for
pediatric patients
IF incidence of infections with
MRSA >10% in an institution,
vancomycin is recommended,
otherwise it is optional
(IF incidence of infections with MRSA
>10% in an institution, vancomycin is
recommended, otherwise it is
optional)
Orthopedics
LIKELY
PATHOGENS
ANTIMICROBIAL REGIMEN
(Adult)
ANTIMICROBIAL REGIMEN
(Pediatric)
OR REDOSING
COMMENTS
Total joint
replacement
Staphylococcus aureus
and Staphylococcus
epidermidis and various
streptococci cause
>66% of wound
infections.
• Cefazolin1,4 1 g IV preop
(2 g if > 80 kg)
• Cefazolin 25mg/kg IV preop
(Maximum of 1 g)
• Cefazolin every 4
hours
----- or
---- Or
• Cefuroxime every 4
hours
Cefuroxime has enhanced activity
against coagulase-negative
staphylococci
Hip fracture
repair
Staphylococci
5
• Cefuroxime 1.5 g IV preop
• Cefuroxime 30mg/kg IV
preop (Maximum of 1.5 g)
----- or
---- Or
• Vancomycin (15 mg/kg), up
to 1 g IV
pre-op if MRSA+
• Vancomycin 15mg/kg IV
(Maximum of 1 g) preop if
MRSA+
• Cefazolin1,4 1 g IV pre-op
(2 g if > 80 kg)
• Cefazolin 25mg/kg IV preop
(Maximum of 1 g)
• Cefazolin every 4
hours
----- or
---- Or
• Cefuroxime every 4
hours
5
• Cefuroxime 1.5 g IV preop
• Cefuroxime 30mg/kg IV
preop (Maximum of 1.5 g)
----- or
---- Or
• Vancomycin (15 mg/kg) up
to 1 g IV if MRSA+
• Vancomycin 15mg/kg IV
(Maximum of 1 g) preop if
MRSA+
• Vancomycin none;
every 6 hours for
pediatric patients
• Vancomycin none;
every 6 hours for
pediatric patients
Use vancomycin only for severe
penicillin allergy or if MRSA+.
Some clinicians use clindamycin
in penicillin-allergic patients
Use vancomycin only for severe
penicillin allergy or MRSA+.
Some clinicians use clindamycin
in penicillin-allergic patients