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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

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antibioprophylaxis in surgery and mdros

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
slide5
Plan
  • MDR definition
  • Prophylaxis – spectrum - principles
  • Literature – prophylaxis et SSI MDROs
  • Discussion
definition mdr
Definition MDR
  • Clinicalmicrobinfec 2011: 18(3), 268-281
antibioprophylaxis common principles
Antibioprophylaxiscommonprinciples
  • Limited to wellproven indications
  • Targeted to organismsinvolved in SSI
  • Timing of administration
  • Perop administration if needed
  • Duration < 24 hrs

2013

antibioprophylaxis
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

s pectrum
Spectrum
  • The narrowest
  • Resistance patterns fromorganismscausingSSI shouldtakeprecedenceover hospitalwideantibiograms
  • In somecases, procedure-specificresistancepatterns!

Consensus 2013

s pectrum1
Spectrum
  • Skin incision:

SSI:

~ 80% Gram positive

~ 20% Gram négative

First choice:

anti-staph (oxa-S) + anti bgn

cef 1 (cef2)

2013

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

2013

rec 2013 quid des mdr
Rec 2013 - Quid des MDR?
  • MRSA
  • MDR Enterobacteriacae
  • Pseudomonas aeruginosa
  • VRE

2013

rec 2013 quid des mdr1
Rec 2013 - Quid des MDR?

Consensus 2013

2013

2013 mrsa
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

2013 mr s sa
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

slide20
MRSA
  • Screening vs high risk conditions
    • Pts/units
  • Eradication
  • + Vancomycine

2013

slide21
VRE
  • Enteroccoccusuncovered by conventionalprophylaxis (rare exceptions)
  • VRE to beconsidered in special settings (Li TX, …)

2013

gram neg pubmed
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

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

2013

urology cipror
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

urology customized prophylaxis
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

urology cipro amikacin
Urology / cipro + amikacin

Kehinde J Urol 2013; 189: 911

Historiccontrl : cipro

Intervention: cipro+amika

2013

esbl epidemiology liver tx
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

esbl epidemiology liver tx1
ESBL / epidemiology / liverTx

%pts

2013

Bert , Transplant infect disease, 2013: 1-6

colonisation clinical impact
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

antibioprophylaxis1
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

rec 2013
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

quid gram neg mdr
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

operational considerations
Operationalconsiderations
  • Preoperativeclinicalpath
  • Customize vs systematic screening (labcosts!)

2013

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