#96 – The Tortured Stewards & Surgeons Department

The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.
 
Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and more!
 
If you’d like more information about the CALIPSO trial, please visit this link: https://www.anzca.edu.au/profiles/ctn-trials/underway/calipso
 
 
Bibliography
  1. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update: https://journals.lww.com/journalacs/citation/2017/01000/american_college_of_surgeons_and_surgical.8.aspx
  2. 2017 CDC Guidelines: https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725
  3. ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery: https://www.ashp.org/surgical-guidelines
  4. de Jonge Meta-Analysis on duration and incidence of SSI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/abstract
  5. Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance: https://www.ahajournals.org/doi/10.1161/01.cir.101.25.2916?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
  6. RCT – Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: https://jamanetwork.com/journals/jama/article-abstract/2810510
  7. NYU Langone Study – Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=91dee3e1445adb80d533f2c210816a3285254e3a
  8. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty: https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
  9. What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744972/
  10. Drug allergy: a 2022 practice parameter update: https://www.jacionline.org/article/S0091-6749(22)01186-1/fulltext
  11. Perioperative use of cefazolin without preliminary skin testing in patients with reported penicillin allergy: https://www.surgjournal.com/article/S0039-6060(18)30307-6/abstract#%20
  12. Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815528

Trisha Peel, MBBShons, GradCertClinRes, FRACP, PhD

Professor Trisha Peel is an infectious diseases clinical researcher who is currently Deputy Director (Research) in the Department of Infectious Diseases at Monash University and Alfred Health in Melbourne, Australia. She leads the Surgical Infection Research Group which conducts clinical trials to prevent surgical site infections while minimizing emergence of antimicrobial resistance.

Michael Calderwood, MD, MPH, FIDSA

Dr. Michael Calderwood is the Chief Quality Officer at Dartmouth Hitchcock Medical Center and an associate professor of medicine at the Geisel School of Medicine at Dartmouth. He has experience in hospital epidemiology and as a leader of antimicrobial stewardship programs at Dartmouth and previously at Harvard Medical School.

Patch Dellinger, MD

Dr. Patch Dellinger is a professor emeritus at University of Washington Harborview Medical Center. His experience completing an infectious diseases fellowship helped establish him as an innovator in the world of surgery and a leader in reducing surgical site infections. He was a pioneer of the now standard “surgical checklist” as a standardization tool to prevent errors. 

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