Antibiogram

 

Introduction

Antibiogram is a web application designed to provide VA medical staff easy access to antibiograms (antibiotic resistance data collected from actual in-vitro testing) from any VA facility. The ready availability of antibiogram data through the Antibiogram app should lead to increased utilization of antibiogram data and more effective antibiotic administration.

To download this information as a PDF, click here.

 

Bacterial Endocarditis Prophylaxis

Recent guidelines from the American Heart Association & American College of Cardiology are suggesting antimicrobial prophylaxis only for patients having underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis:

Prosthetic heart valve
History of endocarditis
Congenital Heart Disease:

  • unrepaired cyanotic CHD, including palliative shunts or conduits
  • completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure
  • repaired CHD with residual effects at the site or adjacent to the site of a prosthetic patch or device
  • cardiac transplant recipients with cardiac valvular disease.

 

Treatment: 30-60 mins pre-procedure (pediatric doses in parantheses)

Dental, Oral, Respiratory Tract or Esophagel procedures **

Amoxicillin 2 g PO (50mg/kg)
Ampicillin 2 g IV/IM (50mg/kg)
Clindamycin 600mg PO/IV (20mg/kg)
Cephalexin 2g PO (50mg/kg)
Ceftriaxone 1 g IV/IM (50mg/kg)
Cefazolin 1 g IV/IM (50mg/kg)
Azithromycin 500mg PO (15mg/kg)


**involving incision, biopsy, or respiratory tract or manipulation of gingival tissue, periapical region of teeth or perforation of oral mucosa (Viridans streptococci (alpha-hemolytic streptococci) most prevalent bacteria)

 

Infected skin, skin structure or muscoloskeletal tissue

Treat with agents active against staphylococci and beta-hemolytic streptococci:
antistaphylococcal PCN (oxacillin) or cephalosporin (see above doses)
If MRSA suspected in wound/skin structure: (or intolerant of beta-lactam)
Vancomycin 15-20mg/kg for adults up to 2 g or (15mg/kg to 1 g for children)

 

GI or Genitourinary Tract

(prophylaxis solely to prevent endocarditis NOT recommended)
IF: An  enterococcal UTI present, treat before an elective GU procedure or include enterococcal coverage perioperatively for non-elective procedures.

IF: exisiting GI or GU infection or receiving perioperative antibiotics to prevent surgical site infection or sepsis, it is reasonable to include an agent with activity against enterococci.

 

Pre-op antibiotic recommendations

General

Procedure Recommended Alternate if allergic
Appendectomy for uncomplicated appendicitis cefoxitin or cefazolin + metronidazole clindamycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Biliary tract cefazolin or cefoxitin or ceftriaxone (if infected) clindamycin or vancomycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Cardiac device insetion (pacer) cefazolin clindamycin or vancomycin
Colorectal

cefazolin + metronidazole OR cefoxitin OR ertapenem
OR ceftriaxone + metronidazole

clindamycin + AMG aztreonam or FQ OR metronidazole + AMG or FQ
Gastroduodenal cefazolin clindamycin or vancomycin + AMG or aztreonam or FQ

 

Head & Neck

Procedure Recommended Alternate if allergic
Clean None None
Clean with prosthesis (excludes tympanostomy tubes) cefazolin or cefoxitin clindamycin
Clean-contaminated (except tonsillectomy and functional endoscopic sinus procedures cefazolin or cefoxitin + metronidazole clindamycin
Hernia Repair - clean cefazolin clindamycin or vancomycin
C-Section cefazolin clindamycin + AMG
Hysterectomy (vaginal or abdominal) cefazolin or cefoxitin clindamycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Ophthalmic

neomycin/ polymixin/ B-gramicidin
or moxifloxacin or gatifloxacin

 

 

Orthopedic

Procedure Recommended Alternate if allergic
Clean w/o implant None None
Hip fracture, implant of internal fixation device, or total joint replacement cefazolin clindamycin or vancomycin

 

Plastics

Procedure Recommended Alternate if allergic
Clean None Non
Clean with risk factors or clean-contaminated cefazolin clindamycin or vancomycin

 

Small Intestines

Procedure Recommended Alternate if allergic
Non-obstructed cefazolin clindamycin + AMG or aztreonam or FQ
Hip fracture, implant of internal fixation device, or total joint replacement cefazolin + metronidazole
OR cefoxitin
metronidazole + AMG or FQ

 

Urologic

Procedure Recommended Alternate if allergic
Lower tract instrumentation with risk factors (includes transrectal prostate biopsy) FQ or TMP/SMX
or cefazolin
AMG +/- clindamycin
Clean w/o entry into tract cefazolin clindamycin or vancomycin
...with implanted prosthesis cefazolin +/- AMG or axtreonam clindamycin or vancomycin +/- AMG or aztreonam
Clean w/ entry into tract cefazolin FQ OR AMG +/- clindamycin
Clean-contaminated cefazolin + metronidazole
OR cefoxitin
FQ OR AMG + metronidazole or clindamycin
Vascular cefazolin clindamycin or vancomycin