Antibiotic Prophylaxis, Vascular Surgery in Adults (681)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations

Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.
For gentamicin# dose see surgical prophylaxis dosing tables.

  • If >1.5 L blood loss replace fluid and repeat antibiotic dose: flucloxacillin, metronidazole. Give half the original teicoplanin dose if ≥1.5 L blood loss within the first hour of operation. Once bleeding is controlled, measure gentamicin concentration. If the gentamicin concentration is < 2.0mg/L re-dose with half the original gentamicin dose.

If surgery >4hrs re-dose flucloxacillin;
>8hrs re-dose, flucloxacillin metronidazole. No repeat dosing of teicoplanin if surgery prolonged.

If surgery is expected to continue for > 8hours from first gentamicin dose,
Measure the gentamicin concentration at 6 hours. If the gentamicin concentration is < 2.0 mg/L re-dose with half the original gentamicin dose

If surgery continues for > 8hours from first antibiotic dose and > 1.5L blood loss

  • Once bleeding is controlled, measure the gentamicin concentration. If the gentamicin concentration is < 2.0mg/L re-dose with half the original gentamicin dose.

If MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology antibiotic choice.

CPE carriers: If identified as Carbapenamase producing Enterobacterales carriers contact microbiology

Weight >80 Kg

Increase the dose of antibiotic as below:

  > 80 Kg > 160 Kg
Metronidazole 1000 mg 1500 mg

 

Table: Procedure> Antibiotic

Comment: Perform MRSA screening prior to planned surgery. High risk if: previous/ current MRSA carriage, hospitalisation or antibiotic therapy in previous 4 weeks, poorly controlled diabetes, tissue loss or recent foot sepsis.

Procedure Antibiotic
Vascular surgery
Lower limb amputation
IV Flucloxacillin 2 g
+ IV Metronidazole 500 mg
+/- Gentamicin#
If true penicillin / beta-lactam allergy or high MRSA risk,
replace Flucloxacillin 2 g with IV Teicoplanin 400 mg
Arterial reconstruction/graft/ prosthetic

IV Flucloxacillin 2 g
+/- Gentamicin#
If true penicillin / beta-lactam allergy or high
MRSA risk,
Teicoplanin 400 mg

Diabetic patients
Add
IV Metronidazole 500 mg
(to flucloxacillin or teicoplanin)

Last reviewed: 23 March 2021

Next review: 29 February 2024

Author(s): Ysobel Gourlay

Version: 2

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 681