Surgery of Intestinal or Genitourinary Tract
Single-drug regimens
Piperacillin-tazobactam 3.375 g every 6 h or 4.5 g every 8 h IV
Imipenem- 500 mg every 6 h IV/ Meropenem1 g every 8 h IV
Combination regimens
Ceftriaxone 1 g every 24 h + metronidazole 500 mg every 8 h IV
Ciprofloxacin 400 mg IV every 12 h or 750 mg po x 12 h + metronidazole 500 mg every 8 h IV
Surgery of trunk or extremity away from axilla or perineum
Cloxacillin or flucloxacillin
Cefazolin 0.5–1 g every 8 h IV
Surgery of axilla or perineum
Metronidazole 500 mg every 8 h IV Plus Ciprofloxacin 400 mg IV every 12 h or 750 mg po x 12 h

In the ICMR’s surveillance data, 39% of the 12,336 isolates from out-patients and 32% of the isolates from ward were from pus samples. Gram negative pathogens accounted for 76% isolates from the surgical site and 62% from pus, which should have an important bearing which framing treatment guidelines, especially, since most guidelines target S. aureus.The overall rate of MRSA was 32% for the year 2017. The commonest species of CONS were S. haemolyticus and S. epidermidis, the former had MR rate of 86.6% & the latter 61%.

The profile of surgical site isolates in the ICMR surveillance data is as under:

OPD - 11.6 %
IPD - 68.6 %
ICU - 19.8 %

Organisms

Enterobacteriaceae – 46.20%
Salmonella – 0.3%
NFGNB – 27.4%
Staphylococcus – 7%
Enterococcus – 16.8%
Fungi – 0.8%
Faceal pathogens– 1.5%

Pus samples

OPD – 33.2%
Wards – 57.4%
ICU – 9.3%

Organisms

Enterobacteriaceae– 38.3%
Salmonella – 0.1%
NFGNB – 23.7%
Staphylococcus – 33.3%
Enterococcus – 44%
Fungi – 0.2%
Faecal pathogens – 0%