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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESoon-to-be published guidelines from the American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), and Surgical Infection Society (SIS) will offer updated clinical directives for antimicrobial prophylaxis in surgery. They will be the first collaborative guidelines offered by the 4 societies.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInfectious Disease Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EScreening \u0026amp; Prevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESoon-to-be published guidelines from the American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), and Surgical Infection Society (SIS) will offer updated clinical directives for antimicrobial prophylaxis in surgery. They will be the first collaborative guidelines offered by the 4 societies. E. Patchen Dellinger, MD, University of Washington, Seattle, USA, presented an overview of the guidelines. The recommendations apply primarily to adults aged \u226519 years and children 1 to 18 years, although Dr. Dellinger cautioned that there is a lack of prospective studies for the pediatric group.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EWhen making these recommendations, the guideline writing group thought in terms of the goals of an \u201cideal agent.\u201d It should prevent surgical site infection (SSI) and related morbidity and mortality, be safe, have no consequences to the microbial flora of the patient or hospital, and reduce the duration and cost of health care. In addition, an ideal agent should be active against the pathogens likely to be in the wound and given at an appropriate dose but for the shortest possible time. As for selection of first-choice drug for each procedure, the guidelines are based mostly on expert opinion and take into account a number of factors such as cost, safety, allergy potential, ease of administration, pharmacokinetics, antibacterial activity, and efficacy in a specific procedure. Dr. Dellinger added that there is no evidence that broad-spectrum agents are more effective. For most procedures cefazolin is effective, while metronidazole can be added when anaerobic activity is needed.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ECephalosporins should not be used in patients with documented IgE-mediated allergic reactions (such as anaphylaxis, urticaria, bronchospasm), Stevens-Johnson syndrome, and toxic epidermal necrolysis to \u03b2-lactam antibiotics. Cephalosporins and carbapenems can safely be used in patients with reactions to penicillin other than those listed. The optimal time to administer the preoperative dose is within 60 minutes of incision; for vancomycin and fluoroquinolones the time is 120 minutes, and there does not seem to be convincing evidence that administration closer to the time of incision is less effective. Dosing should ensure that there are adequate levels of drug present in serum both in the early and late phases of the procedure. The guidelines recommend weight-based dosing. The re-dosing interval should be measured from the time of the initial preoperative dose and applied at 2 half-lives of the drug. Duration should be \u0026lt;24 hours for most procedures.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients colonized with \u003Cem\u003EStaphylococcus aureus\u003C\/em\u003E are at increased risk for SSI. Mupirocin is recommended for decolonization. Although not recommend for routine use, vancomycin may be included when there is a cluster of methicillin-resistant \u003Cem\u003ES. aureus\u003C\/em\u003E (MRSA) or methicillin-resistant \u003Cem\u003EStaphylococcus\u003C\/em\u003E epidermidis (MRSE) SSI or for patients known to be colonized with methicillin-sensitive \u003Cem\u003ES. aureus\u003C\/em\u003E (MSSA). Because of its superior efficacy against MSSA, cefazolin can be added in patients without serious \u03b2-lactam allergy.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EFor colorectal operations, mechanical bowel prep plus oral antibiotics the day before operation combined with appropriate parenteral antibiotics achieves a lower SSI rate than parenteral antibiotics alone with or without bowel prep. The guidelines recommend 3 doses of oral antibiotics (neomycin plus erythromycin or metronidazole) taken the day before surgery (over approximately 10 hours after bowel prep). Dr. Dellinger suggested 8 areas where he believes future antibiotic research should be directed (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The new guidelines are expected to be published later this year.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12909\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12909\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12909\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EAreas for Future Research.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/14\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzna41\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzna41\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}