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Antibioprophylaxis in surgery and MDROs Atelier antibioprophylaxie en chirurgie Workshop Antibiotica profylaxe in de chirurgie Baudouin Byl Hygiène Hospitalière.

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Presentation on theme: "Antibioprophylaxis in surgery and MDROs Atelier antibioprophylaxie en chirurgie Workshop Antibiotica profylaxe in de chirurgie Baudouin Byl Hygiène Hospitalière."— Presentation transcript:

1 Antibioprophylaxis in surgery and MDROs Atelier antibioprophylaxie en chirurgie Workshop Antibiotica profylaxe in de chirurgie Baudouin Byl Hygiène Hospitalière et Gestion de lantibiothérapie Hôpital Erasme – ULB

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5 Plan MDR definition Prophylaxis – spectrum - principles Literature – prophylaxis et SSI MDROs Discussion

6 Definition MDR Clinical microb infec 2011: 18(3),

7 Definition MDR

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9 20139 Antibioprophylaxis common principles Limited to well proven indications Targeted to organisms involved in SSI Timing of administration Perop administration if needed Duration < 24 hrs

10 Antibioprophylaxis new recommendations Bratzler DW et al Am J Health-Sys Pharm Vol 70, feb1, 2013 previous: Clin Infect Dis, 1994; 18: ASHP IDSA SHEA SIS

11 Spectrum The narrowest Resistance patterns from organisms causing SSI should take precedence over hospitalwide antibiograms In some cases, procedure-specific resistance patterns! Consensus 2013

12 Spectrum Skin incision: SSI: ~ 80% Gram positive ~ 20% Gram négative First choice: anti-staph (oxa-S) + anti bgn cef 1 (cef2)

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14 From 1994 to 2013 … Dramatic decrease in sensitivity to cef1 (cef2) MDR ….

15 R rate cef1 cef2, enterobacterial species Erasme

16 Rec Quid des MDR? MRSA MDR Enterobacteriacae Pseudomonas aeruginosa VRE …

17 Rec Quid des MDR? Consensus 2013

18 / MRSA Glycopeptides en prophylaxie –Consensus 2013 Cluster of MRSA or MRSE known MRSA colonisation (or at high risk) AND who will have a skin incision !!! vanco less effective on MSSA !!! –czol+vanco! (Specific setting: community MRSA)

19 / MR(S)SA From controverse to growing evidence… S aureus carriage eradication recommended –Cardiac surgery –Orthopedic surgery –Spinal procedures ! Surveillance of R to mupi ! ? Timing? Duration? ! operational considerations ! (BB) Consensus 2013

20 MRSA Screening vs high risk conditions –Pts/units Eradication + Vancomycine

21 VRE Enteroccoccus uncovered by conventional prophylaxis (rare exceptions) VRE to be considered in special settings (Li TX, …)

22 Enterobacteriaceae

23 Gram neg / PUBMED MDR / prophylaxis / surgery : 0 Carbapenemase / SSI / prophylaxis: 0 Carbapenemase / prophylaxis: 0 ESBL / prophylaxis: 47 –Surgery urology - 4 transplantation - 1 obesity (pharmaco ertapenem)

24 MDR carriage / exposition to antibiotics Abundant literature – overlaps between: –ESBL –UTI –Neutropenic patients –Quinolone use

25 Urology / ciproR Urology Transrectal prostate biopsy E coli : first causative (75- 90%) Haute prévalence esbl et ciproR E coli ciproR 17%!!! Quid proph quinolones? Qi et al J Urol 2013: 2026 Williamson et al, CID, 2013:267

26 Urology / customized prophylaxis FQ vs [ctri or genta or sxt or cefpodox] Reduction infection / ctrl histor by screening and adapted prophylaxis Reduction infection Taylor J Urol 2012: 1275 Duplessis et al Urology 2012:

27 Urology / cipro + amikacin Kehinde J Urol 2013; 189: 911 Historic contrl : cipro Intervention: cipro+amika

28 ESBL / epidemiology / liver Tx Independant risk factors – fecal carriage ESBL –Previous infection with ESBL –Previous Blactam –Previous SBP (quinolones!) Need for targeted prophylaxis Bert, Transplant infect disease, 2013:0: 1-6

29 ESBL / epidemiology / liver Tx Bert, Transplant infect disease, 2013: 1-6 %pts

30 Colonisation / Clinical impact ICU ~7 % infections caused by ESBL+ –Among carriers 10% first infection and 27% second infection caused by ESBL+ Razazi Int Care Med 2012; 38:

31 ESBL / prophylaxis

32 Antibioprophylaxis new recommendations Bratzler DW et al Am J Health-Sys Pharm Vol 70, feb1, 2013 previous: Clin Infect Dis, 1994; 18:

33 Rec 2013 Transplanted pts (liver, lungs): –Include coverage for any potential pathogen (isolated < donor / receiver) Colo-rectal –czol+ metro –Or ctri+metro (if high R cef1/2) [or ertapenem!!] Consensus 2013

34 Quid Gram neg MDRO?

35 Quid Gram neg/MDR? Consider customising –Urology (trans rectal biopsy) –Local SSI epidemiology Screening!(rectal) Screening high risk Customize to screening results Customize to high risk (ex uro!)

36 Operational considerations Preoperative clinical path Customize vs systematic screening (lab costs!)

37 Operational considerations

38 Your opinion?


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