1 / 38

Antibioprophylaxis in surgery and MDROs

Atelier antibioprophylaxie en chirurgie W orkshop Antibiotica profylaxe in de chirurgie. Antibioprophylaxis in surgery and MDROs. Baudouin Byl Hygiène Hospitalière e t Gestion de l’antibiothérapie Hôpital Erasme – ULB. Plan. MDR definition Prophylaxis – spectrum - principles

jamil
Download Presentation

Antibioprophylaxis in surgery and MDROs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Atelier antibioprophylaxie en chirurgie Workshop Antibiotica profylaxe in de chirurgie Antibioprophylaxis in surgery and MDROs • Baudouin Byl • Hygiène Hospitalière • et Gestion de l’antibiothérapie • Hôpital Erasme – ULB

  2. Plan • MDR definition • Prophylaxis – spectrum - principles • Literature – prophylaxis et SSI MDROs • Discussion

  3. Definition MDR • Clinicalmicrobinfec 2011: 18(3), 268-281

  4. Definition MDR

  5. Antibioprophylaxiscommonprinciples • Limited to wellproven indications • Targeted to organismsinvolved in SSI • Timing of administration • Perop administration if needed • Duration < 24 hrs 2013

  6. Antibioprophylaxis • new recommendations Bratzler DW et al Am J Health-Sys Pharm Vol 70, feb1, 2013 ASHP IDSA SHEA SIS previous: Clin Infect Dis, 1994; 18: 422-427 2013

  7. Spectrum • The narrowest • Resistance patterns fromorganismscausingSSI shouldtakeprecedenceover hospitalwideantibiograms • In somecases, procedure-specificresistancepatterns! Consensus 2013

  8. Spectrum • Skin incision: SSI: ~ 80% Gram positive ~ 20% Gram négative First choice: anti-staph (oxa-S) + anti bgn cef 1 (cef2) 2013

  9. From 1994 to 2013 … • Dramaticdecrease in sensitivity to cef1 (cef2) • MDR …. 2013

  10. R rate cef1 cef2, enterobacterialspecies Erasme • 1993-2011 2013

  11. Rec 2013 - Quid des MDR? • MRSA • MDR Enterobacteriacae • Pseudomonas aeruginosa • VRE • … 2013

  12. Rec 2013 - Quid des MDR? Consensus 2013 2013

  13. 2013/ MRSA • Glycopeptides en prophylaxie • Consensus 2013 • Cluster of MRSA or MRSE • known MRSA colonisation (or at high risk) ANDwhowill have a skin incision • !!! vancoless effective on MSSA !!! • czol+vanco! • (Specific setting: community MRSA) 2013

  14. 2013/ MR(S)SA • From controverse to growingevidence… • S aureus carriageeradicationrecommended • Cardiacsurgery • Orthopedicsurgery • Spinal procedures • ! Surveillance of R to mupi ! • ? Timing? Duration? • ! operationalconsiderations! (BB) Consensus 2013 2013

  15. MRSA • Screening vs high risk conditions • Pts/units • Eradication • + Vancomycine 2013

  16. VRE • Enteroccoccusuncovered by conventionalprophylaxis (rare exceptions) • VRE to beconsidered in special settings (Li TX, …) 2013

  17. Enterobacteriaceae 2013

  18. Gram neg / PUBMED • MDR / prophylaxis / surgery : 0 • Carbapenemase / SSI / prophylaxis: 0 • Carbapenemase / prophylaxis: 0 • ESBL / prophylaxis: 47 • Surgery 12 - 7 urology - 4 transplantation - 1 obesity (pharmaco ertapenem) 2013

  19. MDR carriage / exposition to antibiotics • Abundantliterature – overlapsbetween: • ESBL • UTI • Neutropenic patients • Quinolone use 2013

  20. Urology / ciproR • Urology • Transrectal prostate biopsy • E coli : first causative (75-90%) • Haute prévalence esbl et ciproR • E coli ciproR 17%!!! • Quid proph quinolones? Williamson et al, CID, 2013:267 Qi et al J Urol 2013: 2026 2013

  21. Urology / customizedprophylaxis • FQ vs [ctri or genta or sxt or cefpodox] • Reduction infection / ctrl histor • by screening and adaptedprophylaxis • Reductioninfection Duplessis et al Urology 2012: 556-563 Taylor J Urol 2012: 1275 2013

  22. Urology / cipro + amikacin Kehinde J Urol 2013; 189: 911 Historiccontrl : cipro Intervention: cipro+amika 2013

  23. ESBL / epidemiology / liverTx • Independantriskfactors – fecalcarriage ESBL • Previous infection with ESBL • PreviousBlactam • Previous SBP (quinolones!) • Need for targetedprophylaxis Bert , Transplant infect disease, 2013:0: 1-6 2013

  24. ESBL / epidemiology / liverTx %pts 2013 Bert , Transplant infect disease, 2013: 1-6

  25. Colonisation / Clinical impact • ICU ~7 % infections caused by ESBL+ • Among carriers • 10% first infection and 27% second infection caused by ESBL+ Razazi Int Care Med 2012; 38:1769-1778 2013

  26. ESBL / prophylaxis 2013

  27. Antibioprophylaxis • new recommendations Bratzler DW et al Am J Health-Sys Pharm Vol 70, feb1, 2013 previous: Clin Infect Dis, 1994; 18: 422-427 2013

  28. Rec 2013 • Transplanted pts (liver, lungs): • Includecoverage for anypotentialpathogen (isolated < donor / receiver) • Colo-rectal • czol+ metro • Or ctri+metro (if high R cef1/2) • [or ertapenem!!] Consensus 2013 2013

  29. Quid Gram neg MDRO?

  30. Quid Gram neg/MDR? • Considercustomising • Urology (trans rectal biopsy) • Local SSI epidemiology • Screening!(rectal) • Screening high risk • Customize to screening results • Customize to high risk (ex uro!) 2013

  31. Operationalconsiderations • Preoperativeclinicalpath • Customize vs systematic screening (labcosts!) 2013

  32. Operationalconsiderations 2013

  33. Your opinion?

More Related