DOCSLIB.ORG

Antibiotic Surgical Prophylaxis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Antibiotic Surgical Prophylaxis Antibiotic Surgical Prophylaxis (ASP) Decision Flow From antimicrobial prescription Diagram form: documentation for ordering Type of surgical procedure alternative ASP from Pharmacy or Pharmacy Emergency Cupboard Choice of Agent Duration of ASP Recommended options All surgery: only 1 YES NO intra-operatively (<24 hrs) * Primary/ Reason Secondary Option *Cardiothoracic surgery: up to 48 hours 2 Documented colonization Allergy or infection with 3rd Option known pathogen that won’t be covered by WDGMC ASP guideline 1) Indicate indication of antibiotic Please document reason on Rx: Prophylaxis antimicrobial prescription 2) Prescribed as per protocol: form for ordering No, indicate reason alternative antibiotic WDGMC: Effective date: 07-09-2016 (Version 2) Antibiotic Surgical Prophylaxis (ASP) Decision Flow Diagram Appropriate dosage, route and timing of administration ASP should be administered ≤ 60 minutes before skin incision (optimal 30 minutes) Administration after skin incision or > 60 minutes before incision reduces effectiveness; 120 minutes for vancomycin or fluoroquinolones Recommended Dosage, Route and Duration of administration Redosing interval in hours (from initiation of Preoperative dose) Antimicrobial * Redose in event of massive blood Adult Pediatric loss * Amikacin 15-20 mg/kg single dose, IV 10-15 mg/kg single dose IV bolus NA bolus (over 2-3 min) (over 2-3 min) Amoxicillin/clavulanic acid 2.4 g ≥ 70 kg IVI (over 30 min) ≥ 3 mo: 25mg/5mg/kg 4 < 3 mo or < 4kg: 25mg/5 mg/kg IVI (over 30 min) 12 Cefoxitin 2 g IVI (over 30 min) 40 mg/kg IVI (over 30 min) 2 Cefazolin 2 g ≥ 70 kg, 3 gram ≥ 120kg IVI 30 mg/kg IVI (over 30 min) 4 (over 30 min) Cefuroxime 1.5 g IVI (over 30 min) 50 mg/kg IVI (over 30min) 2 Ciprofloxacin 400 mg IVI (over 60 min) 10mg/kg IVI (over 30 min) NA Clindamycin 900 mg ≥ 70 kg;600 mg < 70 kg 10 mg/kg IVI (over 30 min) 4 IVI (over 30 min) Fluconazole 400 mg IVI (over 30 min) 6 mg/kg IVI (over 30 min) NA Gentamicin 5-7 mg/kg/dose Single dose,IVI 2.5 mg/kg/dose IVI (over 60 min) NA infusion (over 60 min) Levofloxacin 500 mg IVI (over 60 min) 10 mg/kg IVI (≤ 250 mg: over 30 min) NA Metronidazole 500 mg – 1 g IVI (over 30 min) 15 mg/kg IVI (30 min) NA Piperacillin-Tazobactam 4.5 g IVI (over 30 min) (over 30 min) *Infants 2-9 mo: 80 2 mg/kg of the piperacillin component IVI *Children > 9 mo and ≤ 40kg: 100 mg/kg of the piperacillin component Vancomycin 15 mg/kg single dose IVI (over 15 mg/kg IVI (over 30 min/ 500 mg) NA 30 min/ 500 mg) WDGMC: Effective date: 07-09-2016 (Version 2) WDGMC Antibiotic Surgical Prophylaxis (ASP) Guideline Type of Procedure Primary Option Secondary Option Beta-lactam allergy Colo-rectal Cefoxitin Amoxicillin/clavulanic acid Clindamycin + Gentamicin Gastro-duodenal Cefazolin Amoxicillin/clavulanic acid Clindamicin Biliary Tract 1;2;5;6 Pipperacilin/Tazobactam Amoxicillin/clavulanic acid Clindamycin + Gentamicin Amoxicillin/clavulanic acid Cefazolin Clindamycin + Gentamicin Kidney Transplant Indication for Fluconazole addition (ASHP Guidelines): high risk for candidiasis: antifungal prophylaxis adjusted for renal function. If pancreas transplant as well: include antifungal prophylaxis Piperacillin -tazobactam Amoxicillin/clavulanic acid Clindamycin + Gentamicin/ Amikacin Liver Transplant 1;3;4 Indication for Fluconazole addition (ASHP Guidelines): includes one or more of the following: known colonization with candida; renal failure; choledochojejunostomy; retransplantation or reoperation Pancreas 1;7 Piperacillin/tazobactam Amoxicillin/clavulanic acid Clindamycin + Gentamicin Head & Neck Amoxicillin/clavulanic acid Cefazolin Clindamycin Vascular & Thoracic Amoxicillin/clavulanic acid Cefazolin Clindamycin Indication for addition of glycopeptide: documented MRSA colonisation/ infection (add single dose of Vancomycin) Gynaecology, Hysterectomy Procedures Cefazolin or Amoxicillin/clavulanic acid Cefoxitin Clindamycin + Gentamicin Orthopaedics Cefazolin Glycopeptide Clindamycin Indication for a glycopeptide: documented MRSA colonization or infection (add single dose of Vancomycin) Amoxicillin/clavulanic acid or Urology Cefuroxime Fluoroquinolone Co-trimoxazole WDGMC: Effective date: 07-09-2016 (Version 2) Reference List Specific references: 1. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. 2013. Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy , 70:195-283 2. Cortes A, Sauvanet A, Bert F, Janny S, Sockeel P, Kianmanesh R, Ponsot P, Ruszniewski P, Belghiti J. 2005. Effect of bilecontamination on immediate outcomes after pancreoticoduodenectomy for tumor.Journal of American College of Surgeons , 202:1 (as referenced by Lermite et al, 2006). 3. Fagiuoli S, Colli A, Bruno R, Craxi A, Gaeta GB, Grossi P, Mondelli MU, Puoti M, Sagnelli E, Stefani S, Toniutto P, Burra P. 2014. Management of infections pre-and post liver transplantation: Report on an AISF consensus conference. Journal of Hepatology , 60: 1075- 1089. 4. Kawecki D, Chmura A, Pacholczyk M, Lagiewska B, Adadynski L, Wasiak D, Malkowski P, Sawicka-Grzelak A, Rokosz A, Szymanowska A, Swoboda-Kopec E, Wroblewska M, Rowinski W, Durlik M, Luczak, M. 2007. Surgical Site Infections in Liver Recipients in the Early Posttransplantation Period: Etiological Agents and Susceptibility Profiles. Transplantation Proceedings , 39:2800-2806. 5. Krajden SK, Yaman M, Fuksa M, Langer JC, Rowan J, Burul CJ, Wooster DL, Deitel M, Borowy ZJ, Smith LC,Baida M, Chong J. 1993. Piperacillin versus Cefazolin given perioperatively to high –risk patients who undergo open Cholecystectomy: a double-blind, randomized trial. Canadian Journal of Statistics , 36: 245-250. Available from: https://www.researchgate.net/publication/14873971_Piperacillin_versus_cefazonlin_given_perioperatively_to_high risk_patients_who_undergo_open_cholecystectomy_A_double-blind_randomized_trial . Date of access: 07-09-2016. 6. Lermite E, Pessaux P, Teyssedou C, Etienne A, Brehant O, Arnaud JP. 2006. Effect of preoperative endoscopic biliary drainage on infections morbidity after pancreatoduodenectomy: a case-control study. The American Journal of Surgery , 195:442-446. 7. Michalak G, Kwiatkowski A, Bieniasz M, Meszaros J, Czerwinski J, Wszola M, Nosek R, Ostrowski K, Chmura A, Danielewicz R, Lisik W, Adadynski L, Fesolowicz S, Dobrowolska A, Durlik M and Rowinski W. 2005. Infectious complications after simultaneous pancreas-kidney transplantation. Transplantation Proceedings , 37:3560-3563. General references: • South Australian expert Advisory Group on Antibiotic Resistance (SAAGAR). 2013. Policy clinical guideline surgical antibiotic prophylaxis guideline. Available from: www.sahealth.sa.gov.au • CHOC Children's antibiotic for surgical prophylaxis guideline. 2010. Available from: http://www.choc.org • SIGN: Scottish Intercollegiate Guidelines Network, NHS, Healthcare Improvement Scotland. 2008. Antibiotic prophylaxis in surgery, a national clinical guide. Available from: http://www.sign.ac.uk/guidelines/fulltext/104/ • NHS foundation trust, Royal Devon and Exeter. 2011. Adult surgical antibiotic prophylaxis guidelines. Available from: http://www.rdehospital.nhs.uk/docs/prof/antimicrobial/Surgical_prophylaxis_guidelines.pdf • Mediclinic. 2013. Corporate policy surgical antimicrobial prophylaxis WDGMC: Effective date: 07-09-2016 (Version 2).
Load more

Recommended publications
  • Use of Ceftaroline Fosamil in Children: Review of Current Knowledge and Its Application
    Infect Dis Ther (2017) 6:57–67 DOI 10.1007/s40121-016-0144-8 REVIEW Use of Ceftaroline Fosamil in Children: Review of Current Knowledge and its Application Juwon Yim . Leah M. Molloy . Jason G. Newland Received: November 10, 2016 / Published online: December 30, 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT infections, CABP caused by penicillin- and ceftriaxone-resistant S. pneumoniae and Ceftaroline is a novel cephalosporin recently resistant Gram-positive infections that fail approved in children for treatment of acute first-line antimicrobial agents. However, bacterial skin and soft tissue infections and limited data are available on tolerability in community-acquired bacterial pneumonia neonates and infants younger than 2 months (CABP) caused by methicillin-resistant of age, and on pharmacokinetic characteristics Staphylococcus aureus, Streptococcus pneumoniae in children with chronic medical conditions and other susceptible bacteria. With a favorable and those with invasive, complicated tolerability profile and efficacy proven in infections. In this review, the microbiological pediatric patients and excellent in vitro profile of ceftaroline, its mechanism of action, activity against resistant Gram-positive and and pharmacokinetic profile will be presented. Gram-negative bacteria, ceftaroline may serve Additionally, clinical evidence for use in as a therapeutic option for polymicrobial pediatric patients and proposed place in therapy is discussed. Enhanced content To view enhanced content for this article go to http://www.medengine.com/Redeem/ 1F47F0601BB3F2DD. Keywords: Antibiotic resistance; Ceftaroline J. Yim (&) fosamil; Children; Methicillin-resistant St. John Hospital and Medical Center, Detroit, MI, Staphylococcus aureus; Streptococcus pneumoniae USA e-mail: [email protected] L.
    [Show full text]
  • Cusumano-Et-Al-2017.Pdf
    International Journal of Infectious Diseases 63 (2017) 1–6 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature a a b c b Lucas R. Cusumano , Vivy Tran , Aileen Tlamsa , Philip Chung , Robert Grossberg , b b, Gregory Weston , Uzma N. Sarwar * a Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA b Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA c Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska, USA A R T I C L E I N F O A B S T R A C T Article history: Background: Medical tourism is increasingly popular for elective cosmetic surgical procedures. However, Received 10 May 2017 medical tourism has been accompanied by reports of post-surgical infections due to rapidly growing Received in revised form 22 July 2017 mycobacteria (RGM). The authors’ experience working with patients with RGM infections who have Accepted 26 July 2017 returned to the USA after traveling abroad for cosmetic surgical procedures is described here. Corresponding Editor: Eskild Petersen, Methods: Patients who developed RGM infections after undergoing cosmetic surgeries abroad and who ?Aarhus, Denmark presented at the Montefiore Medical Center (Bronx, New York, USA) between August 2015 and June 2016 were identified. A review of patient medical records was performed. Keywords: Results: Four patients who presented with culture-proven RGM infections at the sites of recent cosmetic Mycobacterium abscessus complex procedures were identified.
    [Show full text]
  • Antimicrobial Surgical Prophylaxis
    Antimicrobial Surgical Prophylaxis The antimicrobial surgical prophylaxis protocol establishes evidence-based standards for surgical prophylaxis at The Nebraska Medical Center. The protocol was adapted from the recently published consensus guidelines from the American Society of Health-System Pharmacists (ASHP), Society for Healthcare Epidemiology of America (SHEA), Infectious Disease Society of America (IDSA), and the Surgical Infection Society (SIS) and customized to Nebraska Medicine with the input of the Antimicrobial Stewardship Program in concert with the various surgical groups at the institution. The protocol established here-in will be implemented via standard order sets utilized within One Chart. Routine surgical prophylaxis and current and future surgical order sets are expected to conform to this guidance. Antimicrobial Surgical Prophylaxis Initiation Optimal timing: Within 60 minutes before surgical incision o Exceptions: Fluoroquinolones and vancomycin (within 120 minutes before surgical incision) Successful prophylaxis necessitates that the antimicrobial agent achieve serum and tissue concentrations above the MIC for probable organisms associated with the specific procedure type at the time of incision as well as for the duration of the procedure. Renal Dose Adjustment Guidance The following table can be utilized to determine if adjustments are needed to antimicrobial surgical prophylaxis for both pre-op and post-op dosing. Table 1 Renal Dosage Adjustment Dosing Regimen with Dosing Regimen with CrCl Dosing Regimen with
    [Show full text]
  • Antimicrobial Stewardship Guidance
    Antimicrobial Stewardship Guidance Federal Bureau of Prisons Clinical Practice Guidelines March 2013 Clinical guidelines are made available to the public for informational purposes only. The Federal Bureau of Prisons (BOP) does not warrant these guidelines for any other purpose, and assumes no responsibility for any injury or damage resulting from the reliance thereof. Proper medical practice necessitates that all cases are evaluated on an individual basis and that treatment decisions are patient-specific. Consult the BOP Clinical Practice Guidelines Web page to determine the date of the most recent update to this document: http://www.bop.gov/news/medresources.jsp Federal Bureau of Prisons Antimicrobial Stewardship Guidance Clinical Practice Guidelines March 2013 Table of Contents 1. Purpose ............................................................................................................................................. 3 2. Introduction ...................................................................................................................................... 3 3. Antimicrobial Stewardship in the BOP............................................................................................ 4 4. General Guidance for Diagnosis and Identifying Infection ............................................................. 5 Diagnosis of Specific Infections ........................................................................................................ 6 Upper Respiratory Infections (not otherwise specified) ..............................................................................
    [Show full text]
  • Susceptibility of Pseudomonas Cepacia Isolated from Children with Cystic Fibrosis1
    003 1-3998/86/2011-1174$02.00/0 PEDIATRIC RESEARCH Vol. 20, No. 1 1, 1986 Copyright O 1986 International Pediatric Research Foundation, Inc. Printed in (I.S.A. Decreased Baseline P-Lactamase Production and Inducibility associated with Increased Piperacillin Susceptibility of Pseudomonas cepacia Isolated from Children with Cystic Fibrosis1 CLAUDIO CHIESA,~PAULINE H. LABROZZI, AND STEPHEN C. ARONOFF Department of Pediatrics [C.C., P.H.L., S.C.A.], Case- Western Reserve University School ofMedicine and the Division of Pediatric Infectious Diseases [S.C.A.], Rainbow Babies and Children's Hospital, Cleveland, Ohio ABSTRACT. The incidence of pulmonary infections in creased since 1978 and is now recovered from 20% of patients children with cystic fibrosis caused by Pseudomonas ce- in some centers (3, 4). pacia, an organism which may possess an inducible 8- Sputum isolates of P. cepacia from children with cystic fibrosis lactamase, has increased since 1978. Seven of 13 sputum are resistant to most P-lactam agents in vitro. In an in vitro study isolates of P. cepacia from children with cystic fibrosis comparing the susceptibilities of 62 consecutive sputum isolates, were classified as inducible by quantitative enzyme produc- concentrations of 64 pg/ml of aztreonam and piperacillin were tion following preincubation with 100, 200, or 400 pg/ml required to inhibit 79 and 87.1 % of the bacterial population, of cefoxitin. The recovery of inducible strains tended to be respectively; 90% of the isolates were inhibited by 8 pg/ml of associated with recent ceftazidime therapy. Susceptibility ceftazidime (5). In vitro, ceftazidime has proven more active to aztreonam, ceftazidime, and piperacillin alone or com- against P.
    [Show full text]
  • Combination Therapy in Complicated Infections Due to S. Aureus
    Combination therapy in complicated infections due to S. aureus Alex Soriano ([email protected]) Service of Infectious Diseases Hospital Clínic of Barcelona ESCMIDUniversity of Barcelona eLibrary IDIBAPS © by author Staphylococcal dissemination to different organs 30 min after i.v. Infection (using a real-time Sureward, et al. imaging) Identification and treatment of the Staphylococcus aureus reservoir in vivo. J Exp Med 2016; 213: 1141-51 ESCMID eLibrary © by author Surewaard, et al. Identification and treatment of the Staphylococcus aureus reservoir in vivo. J Exp Med 2016; 213: 1141-51 ESCMID eLibrary Liver, Kupfer cell (purple ) © byS. aureus author(green) Surewaard, et al. Identification and treatment of the Staphylococcus aureus reservoir in vivo. J Exp Med 2016; 213: 1141-51 eradication Large cluster of S. from blood aureus inside of KC. Located in phagolysosomes ESCMID eLibrary © by author Surewaard, et al. Identification and treatment of the Staphylococcus aureus reservoir in vivo. J Exp Med 2016; 213: 1141-51 liver ESCMID eLibrary Vancosomes: vancomycin vancomycin (1h before ©or after by) authorwithin liposomes Surewaard, et al. Identification and treatment of the Staphylococcus aureus reservoir in vivo. J Exp Med 2016; 213: 1141-51 liver ESCMID eLibrary © by author Lehar S, et al. Novel antibody–antibiotic conjugate eliminates intracellular S. aureus. Nature 2015; 527: 1-19 ESCMID eLibrary © by author Lehar S, et al. Novel antibody–antibiotic conjugate eliminates intracellular S. aureus. Nature 2015; 527: 1-19 Animal model of S aureus bacteremia. Treatment started after 24h of the infection ESCMID eLibrary single dose © by author ESCMID CaseeLibrary #1 © by author Medical history: A 27 y-o man, without co-morbidity.
    [Show full text]
  • Australian Public Assessment Refport for Ceftaroline Fosamil (Zinforo)
    Australian Public Assessment Report for ceftaroline fosamil Proprietary Product Name: Zinforo Sponsor: AstraZeneca Pty Ltd May 2013 Therapeutic Goods Administration About the Therapeutic Goods Administration (TGA) • The Therapeutic Goods Administration (TGA) is part of the Australian Government Department of Health and Ageing, and is responsible for regulating medicines and medical devices. • The TGA administers the Therapeutic Goods Act 1989 (the Act), applying a risk management approach designed to ensure therapeutic goods supplied in Australia meet acceptable standards of quality, safety and efficacy (performance), when necessary. • The work of the TGA is based on applying scientific and clinical expertise to decision- making, to ensure that the benefits to consumers outweigh any risks associated with the use of medicines and medical devices. • The TGA relies on the public, healthcare professionals and industry to report problems with medicines or medical devices. TGA investigates reports received by it to determine any necessary regulatory action. • To report a problem with a medicine or medical device, please see the information on the TGA website <http://www.tga.gov.au>. About AusPARs • An Australian Public Assessment Record (AusPAR) provides information about the evaluation of a prescription medicine and the considerations that led the TGA to approve or not approve a prescription medicine submission. • AusPARs are prepared and published by the TGA. • An AusPAR is prepared for submissions that relate to new chemical entities, generic medicines, major variations, and extensions of indications. • An AusPAR is a static document, in that it will provide information that relates to a submission at a particular point in time. • A new AusPAR will be developed to reflect changes to indications and/or major variations to a prescription medicine subject to evaluation by the TGA.
    [Show full text]
  • Comparative Ceftaroline Activity Tested Against Staphylococcus Aureus Associated with Acute Bacterial Skin and Skin Structure Infection from a Tertiary Care Center
    RESEARCH PAPER Medical Science Volume : 5 | Issue : 4 | April 2015 | ISSN - 2249-555X Comparative Ceftaroline Activity Tested Against Staphylococcus Aureus Associated with Acute Bacterial Skin and Skin Structure Infection from A Tertiary Care Center KEYWORDS MRSA, Ceftaroline, vancomycin Dr. Umamageswari S. S. M. Dr. S. Habeeb Mohammed Dr. Shameem Banu Associate Professor- Microbiology Associate Professor-Surgery Professor and HOD- Microbiology Chettinad Hospital & Research Chettinad Hospital & Research Chettinad Hospital & Research Insitute Insitute Insitute Dr. Jayanthi S. Associate Professor- Microbiology Chettinad Hospital & Research Insitute ABSTRACT Methicillin resistant Staphylococcus aureus (MRSA), commonest cause of acute bacterial skin and skin structure infection (ABSSSI) has only limited treatment options like vancomycin, Linezolid and teicoplanin. Staphylococcus aureus with reduced susceptibilities to vancomycin is developing nowadays among nosocomial infec- tion. A newest cephalosporin – Ceftaroline has received FDA approval for the treatment of ABSSSI recently has unique activity against MRSA. The aim of the study is to know the prevalence of Staphylococcus aureus in ABSSSI patients and to evaluate the in vitro activity of Ceftaroline, in comparison with other drugs. Minimum Inhibitory Concentration for vancomycin and Ceftaroline were determined by E-test strips. Out of 235 Staphylococcus aureus isolated from ABSSSI patient 32% were MRSA. No vancomycin resistant strain isolated in our study. In vitro, Ceftaroline control the growth of MRSA very effectively at 2mg/ml itself. Ceftaroline is a most welcomed drug in the treatment of MRSA. INTRODUCTION: MATERIALS AND METHODS: Complicated skin and skin structure infection (CSSSIs), now This study was carried out in Chettinad health city and known by the new US FDA as Acute bacterial skin and skin Research Institute, a tertiary care center hospital (Chen- structure infections (ABSSSI) are the most common infec- nai) between April 2013 and May 2014.
    [Show full text]
  • Penicillin Allergy Guidance Document
    Penicillin Allergy Guidance Document Key Points Background Careful evaluation of antibiotic allergy and prior tolerance history is essential to providing optimal treatment The true incidence of penicillin hypersensitivity amongst patients in the United States is less than 1% Alterations in antibiotic prescribing due to reported penicillin allergy has been shown to result in higher costs, increased risk of antibiotic resistance, and worse patient outcomes Cross-reactivity between truly penicillin allergic patients and later generation cephalosporins and/or carbapenems is rare Evaluation of Penicillin Allergy Obtain a detailed history of allergic reaction Classify the type and severity of the reaction paying particular attention to any IgE-mediated reactions (e.g., anaphylaxis, hives, angioedema, etc.) (Table 1) Evaluate prior tolerance of beta-lactam antibiotics utilizing patient interview or the electronic medical record Recommendations for Challenging Penicillin Allergic Patients See Figure 1 Follow-Up Document tolerance or intolerance in the patient’s allergy history Consider referring to allergy clinic for skin testing Created July 2017 by Macey Wolfe, PharmD; John Schoen, PharmD, BCPS; Scott Bergman, PharmD, BCPS; Sara May, MD; and Trevor Van Schooneveld, MD, FACP Disclaimer: This resource is intended for non-commercial educational and quality improvement purposes. Outside entities may utilize for these purposes, but must acknowledge the source. The guidance is intended to assist practitioners in managing a clinical situation but is not mandatory. The interprofessional group of authors have made considerable efforts to ensure the information upon which they are based is accurate and up to date. Any treatments have some inherent risk. Recommendations are meant to improve quality of patient care yet should not replace clinical judgment.
    [Show full text]
  • TML\MSH Microbiology Department Policy & Procedure Manual Policy
    TML\MSH Microbiology Department Policy # MI\ANTI\04\03\v03 Page 1 of 5 Policy & Procedure Manual Section: Antimicrobial Susceptibility Testing Subject Title: Appendix III - Double Disk Manual Test for ESBL Issued by: LABORATORY MANAGER Original Date: January 10, 2000 Approved by: Laboratory Director Revision Date: November 21, 2005 APPENDIX III - DOUBLE DISK TEST FOR ESBL I. Introduction Class A or Bush Group 1 extended spectrum beta-lactamases (ESBLs) are inhibited by clavulanic acid. This may be detected by testing the suspected organism to a 3rd generation cephalosporin alone and in combination with clavulanic acid. If the combination results in an expanded zone of inhibition compared to that of the 3rd generation cephalosporin alone, it is indicative of the presence of an ESBL. II. Materials Mueller-Hinton (MH) agar (150) mm 20/10 mg amoxicillin-clavulanate disc 30 mg ceftazidime disc 30 mg ceftriaxone or cefotaxime disc 30 mg aztreonam disc 10 mg cefpodoxime disc (optional) 30 mg cefoxitin disc Quality control strain: E. coli ATCC 51446 III. Procedure 1. Prepare a bacterial suspension of the organism to be tested that has a turbidity equivalent to that of a 0.5 McFarland standard. 2. Inoculate a Mueller-Hinton agar plate with this suspension in accordance with NCCLS M100-S10 (M2) guidelines for disc diffusion testing. 3. Place the amoxicillin-clavulanic acid disc towards the centre of the plate. 4. Carefully measure 15 mm out from the edge of that disc at 90o angles marking the plate. 5. Place a ceftazidime disk on the plate so that its inner edge is 15 mm (the mark) from the amoxicillin-clavulanic acid disc (See Figure 1 KB-ESBL Template).
    [Show full text]
  • Ampicillin/Sulbactam Vs. Cefoxitin for the Treatment of Pelvic Inflammatory Disease
    Infectious Diseases in Obstetrics and Gynecology 5:319–325 (1997) © 1998 Wiley-Liss, Inc. Ampicillin/Sulbactam Vs. Cefoxitin for the Treatment of Pelvic Inflammatory Disease Joseph G. Jemsek* and Frank Harrison Department of Obstetrics and Gynecology, Charlotte Memorial Hospital, Charlotte, NC ABSTRACT Objective: The safety and efficacy of ampicillin plus sulbactam were compared with those of ce- foxitin in the treatment of women with pelvic inflammatory disease (PID). Methods: This single-site, randomized, prospective, third-party-blinded, comparative, parallel- treatment study enrolled 93 women with a diagnosis of PID. Patients were treated with either ampicillin/sulbactam (2 g/1 g, administered intravenously [IV], every 6 h) or cefoxitin (2 g, admin- istered IV, every 6 h) for a minimum of 12 doses. Patients with cultures positive for Chlamydia trachomatis also received concurrent oral or IV doxycycline (100 mg twice daily). Patients with cultures negative for C. trachomatis received prophylactic oral doxycycline (100 mg twice daily) for 10–14 days after treatment with either ampicillin/sulbactam or cefoxitin was completed. Results: Ninety-three patients were entered in the study: 47 in the ampicillin/sulbactam arm and 46 in the cefoxitin arm. All 93 patients were evaluable for safety; 61 (66%) were evaluable for efficacy. Demographic characteristics were similar for the groups. Of the 27 evaluable ampicillin/ sulbactam-treated patients, 67% experienced clinical cure, 30% improved, and 4% failed treatment. Respective values for the 34 cefoxitin-treated patients were 68%, 24%, and 9% (P = 0.67). Patho- gens were eradicated in 70% of the women given ampicillin/sulbactam vs. 56% of those who re- ceived cefoxitin (P = 0.64).
    [Show full text]
  • Staphylococcus Aureus Bloodstream Infection Treatment Guideline
    Staphylococcus aureus Bloodstream Infection Treatment Guideline Purpose: To provide a framework for the evaluation and management patients with Methicillin- Susceptible (MSSA) and Methicillin-Resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI). The recommendations below are guidelines for care and are not meant to replace clinical judgment. The initial page includes a brief version of the guidance followed by a more detailed discussion of the recommendations with supporting evidence. Also included is an algorithm describing management of patients with blood cultures positive for gram-positive cocci. Brief Key Points: 1. Don’t ignore it – Staphylococcus aureus isolated from a blood culture is never a contaminant. All patients with S. aureus in their blood should be treated with appropriate antibiotics and evaluated for a source of infection. 2. Control the source a. Removing infected catheters and prosthetic devices – Retention of infected central venous catheters and prosthetic devices in the setting of S. aureus bacteremia (SAB) has been associated with prolonged bacteremia, treatment failure and death. These should be removed if medically possible. i. Retention of prosthetic material is associated with an increased likelihood of SAB relapse and removal should be considered even if not clearly infected b. Evaluate for metastatic infections (endocarditis, osteomyelitis, abscesses, etc.) – Metastatic infections and endocarditis are quite common in SAB (11-31% patients with SAB have endocarditis). i. All patients should have a thorough history taken and exam performed with any new complaint evaluated for possible metastatic infection. ii. Echocardiograms should be strongly considered for all patients with SAB iii. All patients with a prosthetic valve, pacemaker/ICD present, or persistent bacteremia (follow up blood cultures positive) should undergo a transesophageal echocardiogram 3.
    [Show full text]