Operations and likely Surgical Site Infection (SSI) pathogens:
Operations |
Likely Pathogens |
Prophylactic antibiotic before surgery |
|---|---|---|
| Placement of all grafts, prostheses, or implants | Staphylococcus aureus; CoNS |
Cefazolin OR Cefuroxime |
| Cardiac | Staphylococcus aureus; CoNS |
Cefazolin OR Cefuroxime |
| Neurosurgery | Staphylococcus aureus; CoNS |
Cefazolin OR Cefuroxime |
| Breast | Staphylococcus aureus; CoNS |
Cefazolin OR Cefuroxime |
| Ophthalmic |
S. aureus; CoNS; streptococci; Gram negative bacilli |
Topical moxifloxacin given as 1 drop every 5–15 min for 5 doses |
| Orthopedic Total joint replacement, closed fractures/use of nails, bone plates, other internal fixation devices, functional repair without implant/device, trauma |
Staphylococcus aureus; CoNS; Gram-negative bacilli |
Cefazolin
For ‘below-the-belt’ surgeries, Piperacillin-Tazobactam + Clindamycin |
| Non-cardiac thoracic Thoracic (lobectomy, pneumonectomy wedge resection, other non-cardiac mediastinal procedures), closed tube thoracostomy |
Staphylococcus aureus; CoNS; Streptococcus pneumonia; gram-negative bacilli |
Cefazolin OR Cefuroxime OR Ampicillin-sulbactam |
| Vascular | Staphylococcus aureus; CoNS |
Cefazolin OR Cefuroxime |
| Appendectomy | Gram-negative bacilli; anaerobes | Piperacillin-Tazobactam OR Cefoperazone-sulbactam |
| Biliary tract | Gram-negative bacilli; anaerobes | Piperacillin-Tazobactam OR Cefoperazone-sulbactam |
| Colorectal | Gram-negative bacilli; anaerobes | Piperacillin-Tazobactam OR Cefoperazone-sulbactam |
| Gastroduodenal | Gram-negative bacilli; Streptococci; oropharyngeal anaerobes (e.g., peptostreptococci) | Piperacillin-Tazobactam OR Cefoperazone-sulbactam |
| Head and neck (major procedures with an incision through oropharyngeal mucosa) | Staphylococcus aureus; streptococci; oropharyngeal anaerobes (e.g., peptostreptococci) | Amoxicillin-clavulanate OR Ampicillin-sulbactum OR Cefazolin+metronidazole |
| Obstetric and gynecologic | Gram-negative bacilli; enterococci; group B streptococci; anaerobes | Cefazolin OR Ampicillin-sulbactam |
| Urologic | Gram-negative bacilli | Prophylaxis based on pre-operative urine culture susceptibility pattern OR Cefazolin, Cotrimoxazole |