staph surgical infection
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related: Infectious Disease, notes, preop shaving
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S. aureus is the most common pathogen (23%) associated with surgical site infections (SSIs)
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SSIs after CABG can be serious and devastating, with mediastinitis related to S. aureus of particular concern.
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evaluate for nasal carriage 2 weeks before surgery and decolonize if positive.
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prophylaxis: mupirocin ointment for 5 days with or without chlorhexidine gluconate body wash)
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preop: For cardiac surgery, cefazolin is recommended unless a patient is known to have MRSA colonization or has a severe (anaphylactic) β-lactam allergy, in which case vancomycin is used. For optimal benefit, the antibiotic should be administered 1 to 2 hours before incision. For procedures lasting more than several hours, the antibiotic should be redosed during surgery (for example, redose at 3-4 hours for cefazolin).
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Data do not support extending antibiotic prophylaxis beyond 24 hours after cardiac surgery even while drains remain in place.
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For most other surgeries, no additional doses of antibiotic should be given postoperatively, even in cases of intraoperative spillage of gastrointestinal contents. Postoperative antibiotics are only indicated when treating an active infection.